The anatomy of incontinence--what practitioners and patients need to know.

Stress urinary incontinence, a common problem for many women, is caused by hypermobility of the urethra and sphincteric deficiency. Vaginal detachments result in urethral hypermobility and vaginal prolapse. The focus for most clinicians has been solely on the urethra as the contributing factor to stress incontinence. However, to ensure success of continence surgery, a frequently used treatment with many procedural options, a concerted effort must be made to evaluate the global health of the vagina, treat all existing defects, and recreate normal pelvic support anatomy. The anatomy of urinary incontinence, the history of surgical procedures, as well as the advantages and disadvantages of current surgical techniques are described.