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In the early 1980s anterior colporrhaphy was the operation of choice for most gynecologists, with the Burch colposuspension, the long-needle suspensions of Pereyra and Stamey, and the rectus sheath fascial slings just starting to gain popularity. Howard Jones stated in the Obstetrical and Gynecology Survey that from his review of the literature all stress incontinence operations, whatever you did, had a similar success rate of around 75%. This statement was probably true at that time but was a result of a lack of good comparative trials rather than a similar effectiveness of all stress incontinence procedures. This was subsequently shown to be the case when good prospective randomized studies were reported [1, 2]. Thirty years on we are making the same mistake, using untried surgeries and assuming equivalence without evidence.

The 75% rule: all stress incontinence procedures are alike