Expert Opinion

The International Continence Society and Integral Theory Systems for management of the incontinent female. A comparative analysis


Pelviperineology 2007;26(1):25-9

This work critically examines the recommendations of two rival systems for management of pelvic floor dysfunction, those of the International Continence Society (ICS) and the Integral Theory.

The ICS system, is based on the concept that urodynamics findings are “objective’ and therefore “reliable”. Unstable bladder symptoms are said to be unreliable, not surgically curable, and require drug therapy. Only patients with “Genuine Stress Incontinence” (GSI) are surgically curable, and patients with “mixed” incontinence, stress and urge, should not be operated on if urodynamics demonstrated “detrusor instability” (DI), now known as “overactive bladder” (OAB). Rather, anticholinergic therapy is prescribed.

The Integral System is a holistic anatomically based system which encompasses all three pelvic organs, bladder, vagina and ano-rectum. It is based on the Integral Theory, a musculoelastic theory which states that connective tissue damage to the 3 zones of the vagina is the ultimate cause of prolapse and dysfunction in these organs. From this theory has evolved a 3 zone diagnostic system, and a minimally invasive surgical system which uses polypropylene tapes to reinforce damaged ligaments or fascia in 3 zones of the vagina. In the context of this theory, DI, or OAB, and all abnormal urodynamic parameters such as low urethral pressure, intrinsic sphincter deficiency (ISD), low flow, residual urine etc. are not separate entities or clinical conditions. Rather than symptoms, they are considered to be mainly secondary manifestations of connective tissue damage.

The Integral System’s treatment recommendations differ markedly from those of the International Continence Society, in that symptoms of bladder instability and abnormal emptying in the female are considered for the most part surgically curable.

Keywords: Urodynamics; Detrusor instability; Integral theory.