Th e initial objective of this work was to reduce stress incontinence surgery from
a major surgical procedure (requiring up to ten days in hospital) to a minor daycare
operation. From the beginning it was clear that the two major impediments
to achieving this goal were post operative pain and urinary retention. Addressing
these problems became a long and winding road and culminated in the Integral
Th eory.
The IVS ‘tension-free’ tape operation was inspired by Dr Robert Zacharin’s
anatomical studies. Th ough Zacharin suggested that the ligaments and muscles around
the urethra were important for urinary continence control, he did not say how. Th e
observation that implanted foreign materials created scar tissue led to the hypothesis
that a plastic tape inserted in the position of the pubourethral ligament, would leave
behind suffi cient scar tissue to reinforce that ligament, which would then anchor the
muscles for urethral closure.