In 1994 DeLancey published the hammock hypothesis. According to this theory the increase of the urethral closure
pressure depends on the urethral compression by the suburethral supportive tissue and the intraabdominal position of
the proximal urethra and the bladder neck are not the main factors ensuring the continence. In connection with this
new theory Ulmsten published (in 1996) results of the stress incontinence treatment with the tension-free polypropylene
vaginal tape (TVT). This operation represents a revolution in the antiincontinent surgery. The success rate of this
procedure is about 90 % and it is the same in obese and in non obese women. Concomitant TVT and transvaginal procedures
for prolapse do not decrease the effectiveness and do not increase the perioperative and postoperative morbidity.
The procedure is connected with some peroperative (bladder perforation, retropubic haematoma), early postoperative
(urinary retention) and late postoperative complications (urge incontinence, vaginal protrusion of the tape).
In 2003 newly developed tape procedure – TOT (transobturator tape) was an evolutionary step in the improvement of
tape procedures. The evaluation of the efficacy and complications rate of this modification is premature up to this time
but hitherto positive results predetermine this surgical modality to successful expand.
TVT, TOT, antiincontinent surgery, Burch colposuspension, efficacy, complications.