Creating a gold standard surgical device: scientific discoveries leading to TVT and beyond

Occur with internal logical inconsistencies or especially when experimental findings cannot be explained by the existing paradigm.

Crises occur when the dominant paradigm fails to solve problems or when the bases or predictions of the paradigm are invalidated.

Scientific paradigms preceding and succeeding a paradigm shift are so different that their theories are not able to be judged by the same standards. Nor is the change gradual. “Like a gestalt switch, it must occur all at once, or not at all” [1]. Furthermore, the paradigm shift does not merely involve the revision or transformation of an individual theory, it changes the way in which terminology is defined, how the scientists in that field view their subject, and, perhaps most significantly, what questions are regarded as valid, and what rules are used to determine the truth of a particular theory. Examples: the urodynamic paradigm uses pressure readings to guide whether surgery is performed or not. The integral theory paradigm views prolapse and pelvic symptoms as being mainly secondary to ligament laxity, all being surgically repairable.

Is when the paradigm is applied to solve puzzles within the context of the dominant paradigm. Examples are the ICS urodynamic paradigm and the integral theory paradigm

Is a conceptual framework that ultimately leads to a widespread consensus on the appropriate choice of methods, terminology, and on the kinds of experiment that are likely to contribute to increased insights.

A totally different paradigm emerges that seeks to explain the phase in which the underlying assumptions of the field are re-examined and a new paradigm is established.

Using a tape implanted precisely in the anatomical position of a ligament (e.g., pubourethral ligament) to restore its structural function.