[The development of concepts of female (in)continence. Pathophysiology, diagnostics and surgical therapy]

The integral theory postulates that defect ligaments and fascias, which impair the supporting function of the vaginal wall, can cause stress urinary incontinence as well as urgency and voiding dysfunction. The anatomical and pathophysiologic basis for these dysfunctions are presented. Voiding dysfunctions can be treated by the substitution of defect structures using the principle of "restoration of structure leads to restoration of function". Essential elements of this therapeutic algorithm are suburethral vaginal slings (retropubic or transobturatoric), further a posterior sling, which runs through the fossa ischiorectalis and suspends the vaginal vault near the sacrospinal ligaments, thus reconstructing defect uterosacral ligaments. In cystoceles, lateral and medial defects can be restored by ventral meshes, which are fixed at the arcus tendineus fasciae pelvis by lateral transobturatoric slings. The use of polypropylene slings and meshes is well-founded because they are well tolerated in the tissues and through the development of scar tissue lead to neoligaments with long-lasting therapeutic effects.