The Surgical Treatment of Urinary Incontinence in the Female

Progress in the treatment of urinary incontinence of the female is essentially a story of surgical growth and development. Beginning in the eighteenth century with crude operations for the correction of vesicovaginal fistulas, the scope of this type of plastic surgery has so broadened that today most of the congenital and acquired bladder deformities are successfully treated by surgical means. From a practical point of view, it would seem desirable to eliminate methods which appear to be basically unsound and encourage refinement and use of operations already proved. Regardless of the explanations given by the originators of the various operations, investigation fails to indicate convincingly on just what the successful result depends. Continence following repair of the torn or relaxed internal bladder sphincter may simply be a matter of narrowing the urethral lumen. Success following plaiting of the pubovesicocervical muscle sheet (external sphincter) has been attributed to replacement of the