Pressure transmission theory—The Rasputin of incontinence

Enhorning's pressure transmission theory (PTT), though mortally wounded by multiple invalidations from the 1990 Integral Theory of female urinary incontinence (IT), like Rasputin, continues to survive as a theory for continence and incontinence. To examine the questions: How has the PTT survived? What is its contribution to knowledge? This lack of understanding by the surgeons of how and why the MUS works could be held responsible for the large number of major complications reported by the TVT: including, transected urethras, obturator nerve damage, perforation of external iliac vessels, more than 20 deaths. The role of the sling is to strengthen the pubourethral neoligament to prevent the urethra opening out under stress, not to elevate it. Yet, elevating the sling remains the major cause of the most frequent complication of the MUS today, postoperative urinary retention.