History of Prolapse Surgery & Urogynecology
Pelvic organ prolapse (POP) and urinary incontinence have afflicted women throughout recorded history. The evolution of their treatment — from pomegranate pessaries and uterine succussion in ancient Egypt to robotic sacrocolpopexy and synthetic midurethral slings — mirrors the broader arc of surgery: from empiricism, through anatomical understanding, to evidence-based procedural refinement. Urogynecology as a formal specialty is less than 50 years old, yet its roots reach back three and a half millennia.
Ancient and Classical Period (c. 2000 BCE – 200 CE)
The Earliest Records
The earliest documented descriptions of pelvic organ prolapse come from ancient Egypt. The Kahun Gynaecological Papyrus (c. 1835 BCE) — the oldest surviving gynecological text — describes "falling of the womb," prescribing fumigation, massage, and vaginal pessaries. The text notes: "a woman whose posterior, belly, and branching of her thighs are painful — it is the falling of the womb."[1]
The Ebers Papyrus (c. 1550 BCE) recommends topical petroleum, manure, and honey applied to the body as management. Among the earliest known cases of vesicovaginal fistula (VVF) is the mummy of Henhenit, a lady-in-waiting to Mentuhotep II (11th dynasty, c. 2050 BCE), in whom a large VVF was identified by Derry in 1923 during archaeological examination — evidence that obstructed labor was already devastating women 4,000 years ago.[2]
Greek Medicine
Hippocrates (460–370 BCE) described pomegranate pessaries for prolapse reduction. He also advocated "succussion" — inverting the patient and shaking her until gravity reduced the prolapse — a treatment so alarming to modern sensibilities that it is difficult to imagine its routine use. He theorized the uterus as an autonomous, wandering entity.
Soranus of Ephesus (c. 98–138 CE), more rigorous than his predecessors, rejected crude reductive methods and advocated wool tampons soaked in astringent vinegar and half-pomegranate pessaries. He also described excision of gangrenous prolapsed tissue — among the earliest references to surgical intervention.[3]
Avicenna (Ibn Sina, 980–1037 CE) described what appears to represent VVF as a complication of obstructed labor in The Canon of Medicine (1025 CE) — the first such documentation outside Egyptian sources.[4]
Renaissance and Early Modern Period (1500–1800)
Andreas Vesalius (1514–1564) produced the first accurate anatomical descriptions of the female pelvis in De Humani Corporis Fabrica (1543), illustrated by Jan van Calcar — displacing the medieval doctrine of the seven-cell uterus and establishing the anatomical foundation for rational pelvic surgery.
Ambroise Paré (c. 1510–1590, France) designed the first purpose-made vaginal pessaries from brass and waxed cork with attached retrieval threads — an important step from improvised materials toward functional pessary design.
Hendrik van Roonhuyse (1625–1672, Netherlands) reportedly performed uterine extirpation for prolapse, one of the earliest accounts of surgical management.
Hugh Hodge (1796–1873, Philadelphia) invented the Hodge pessary and declared pessaries the "sine qua non" of uterine displacement treatment. Charles Goodyear's 1844 patent for vulcanized rubber revolutionized pessary design, leading to standardized rubber devices by the mid-19th century and modern silicone designs by the 20th.
19th Century: Foundational Surgery
James Marion Sims and Vesicovaginal Fistula (1813–1883)
James Marion Sims is the most influential — and most ethically contested — figure in the history of operative gynecology. Born in Lancaster, South Carolina in 1813, Sims conducted his pivotal experiments between 1845 and 1849 on enslaved African American women with obstetric VVF in Montgomery, Alabama, without informed consent and with minimal or no anesthesia.
His key subjects — Anarcha, Betsey, and Lucy — endured multiple operations. Anarcha underwent 30 procedures before Sims achieved a consistent repair. The innovations that enabled success:
- A duckbill speculum of his own design, enabling direct visualization of the fistula
- Silver wire sutures — their aseptic and anti-inflammatory properties were the decisive technical advance
- Positioning the patient in the knee-chest position (later the Sims lateral position)
In 1852, Sims published "On the Treatment of Vesico-Vaginal Fistula" in the American Journal of the Medical Sciences, establishing the modern surgical approach to VVF repair.[5]
The ethics of Sims's work have been the subject of sustained historical critique — his statues have been removed from public spaces. John Peter Mettauer of Virginia also claims priority, having reported successful VVF closure with wire sutures in a 1838 letter to the Boston Medical and Surgical Journal, predating Sims.[6]
Anatomical Foundations
Alwin Mackenrodt (1859–1925, Berlin) comprehensively described the pelvic connective tissue in 1895, naming the transverse cervical (cardinal) ligament — Mackenrodt's ligament — and providing the anatomical basis for understanding the cardinal support complex. His work proved fundamental to all subsequent prolapse surgery.[7]
The LeFort Colpocleisis (1877)
Léon LeFort (Paris, 1877) described his eponymous procedure — removal of strips of anterior and posterior vaginal epithelium with suturing of the denuded surfaces together, closing the vaginal lumen while preserving lateral drainage channels. Neugebauer of Warsaw performed the first known partial colpocleisis in 1867 but did not publish until 1881. The LeFort colpocleisis remains in current use for elderly, sexually inactive patients who are medically fragile — one of the oldest surgical procedures still performed unchanged.[8]
Abdominal Sacral Hysteropexy — Olshausen (1886)
Robert Olshausen (Germany, 1886) performed the first laparotomy for uterine ventrofixation — abdominal fixation of the uterus to the anterior abdominal wall — establishing the abdominal route as viable for prolapse management.
Manchester-Fothergill Operation (1888–1908)
Archibald Donald (Manchester) performed his first cases in 1888 using a combined anterior colporrhaphy, cervical amputation, and posterior colporrhaphy in a single procedure, formally described in 1908.
William Edward Fothergill (1907–1908) modified Donald's technique by incorporating suturing of the cardinal (Mackenrodt's) ligaments directly to the cervical stump, enhancing uterine suspension. Because Fothergill's publication was more widely read, the original developer's name was largely displaced — the procedure became known as the Manchester repair or Manchester-Fothergill operation.
Core components: anterior colporrhaphy + cervical amputation + cardinal ligament plication. Still performed today as a uterine-sparing option with durable long-term results.[9]
Early 20th Century: Howard Kelly and the Birth of Urogynecology
Howard Atwood Kelly (1858–1943)
Howard Kelly stands as the founding father of urogynecology. One of the four founding professors of Johns Hopkins Hospital (the "Big Four" alongside Osler, Halsted, and Welch), Kelly was appointed the first Professor of Gynecology and Obstetrics at Hopkins in 1889.
His landmark contributions:
- 1893: Invented the air cystoscope — a handheld hollow tube with a glass partition enabling direct visualization of the female bladder and ureteral orifices. In a celebrated 1900 demonstration before the American Surgical Society in Baltimore, Kelly catheterized both ureters in a female patient in under 3 minutes.
- Developed the Kelly clamp, Kelly speculum, and Kelly forceps — instruments still in routine clinical use.
- 1913: Described the Kelly plication stitch — horizontal mattress sutures placed at the urethrovesical junction to narrow the patulous urethra and elevate the bladder neck. This became the basis of the anterior colporrhaphy with Kelly plication, the dominant gynecological treatment for stress urinary incontinence (SUI) throughout much of the 20th century.
- Authored over 550 articles and books over his career, including Operative Gynecology (1898).[10]
Early Sling Procedures
The biological sling concept predates Howard Kelly. Von Giordano (1907) performed the first recorded sling procedure for SUI using a pedicled gracilis muscle graft placed around the urethra. Rudolf Goebell (Germany, 1910) described the pyramidalis muscle placed suburethrally. P. Frangenheim (Germany, 1914) modified Goebell's technique using fascial attachments of the pyramidalis. W. Stoeckel (Germany, 1917) finalized the Goebell-Frangenheim-Stoeckel technique — combining vaginal reconstruction with musculofascial bladder neck plication. This represents the first comprehensive description of a musculofascial pubovaginal sling.[11]
Victor Bonney (1872–1953)
British gynecological surgeon Victor Bonney, co-author of the landmark Textbook of Gynaecological Surgery (1911, with Comyns Berkeley), pioneered uterine conservation surgery. A passionate advocate against routine hysterectomy, he developed the modern myomectomy technique and ultimately performed over 700 myomectomies (1.1% mortality; 38% subsequent pregnancy rate). His personal motivation: his wife had undergone hysterectomy early in their marriage, rendering her sterile. Bonney articulated the mechanical principles of fascial pelvic floor support in accessible analogies (1934) — an early contribution to the conceptualization of prolapse pathophysiology.[12]
Mid-20th Century: The Scientific Foundation
Richard W. Te Linde (1894–1989)
Richard Te Linde, director of gynecology at Johns Hopkins and founder of the Hopkins school of gynecological surgery, published the first edition of Te Linde's Operative Gynecology in 1946. Now in its 13th edition (2020), it remains the definitive reference textbook of operative gynecology — the "bible" of the specialty for over 70 years.[13]
Aldridge Fascial Sling (1942)
Aldridge (1942) described the autologous rectus fascia pubovaginal sling — strips of rectus fascia left attached to the anterior abdominal wall, passed bilaterally along the urethra, and sutured beneath the bladder neck. Designed as a salvage procedure for women who had failed prior incontinence surgery, this technique is the direct ancestor of the modern autologous fascial sling.[14]
Marshall-Marchetti-Krantz Procedure (1949)
Victor F. Marshall, Andrew A. Marchetti, and Kermit E. Krantz described the first retropubic bladder neck suspension in 1949 (Surgery, Gynecology & Obstetrics). Sutures were placed in the periurethral tissue and attached to the periosteum of the pubic symphysis. Originally described for incontinent men after prostatectomy, the procedure was rapidly extended to women. It opened a new era in SUI surgery, though osteitis pubis (pubic symphysis inflammation) was a recognized complication that limited long-term enthusiasm.[15]
First Abdominal Sacrocolpopexy (1962) and the Minimally Invasive Era
Fredrick Lane (1962) is credited with the first description of abdominal sacrocolpopexy for post-hysterectomy vaginal vault prolapse in a four-patient case series (Obstet Gynecol). The procedure — suspension of the vaginal vault to the sacral promontory via a graft through the abdominal route — became the reference standard for apical prolapse repair and remains so today.[16]
Laparoscopic sacrocolpopexy was first described by Camran Nezhat, Farr Nezhat, and Ceana Nezhat (Stanford University) in 1994, demonstrating feasibility of the abdominal approach without open laparotomy and launching the minimally invasive era of apical prolapse repair.[31]
Robotic sacrocolpopexy was first reported by Di Marco DS and colleagues (Mayo Clinic) in 2004 using the da Vinci Surgical System in four patients — demonstrating improved ergonomics and visualization over straight-stick laparoscopy for the technically demanding suture placement at the sacral promontory. The FDA approved the da Vinci system for gynecologic surgery in 2005, driving rapid adoption. Robotic sacrocolpopexy is now performed at most academic centers as the preferred approach for apical prolapse.[32]
McCall Culdoplasty (1957)
Milton McCall (1957) described posterior culdoplasty during vaginal hysterectomy, obliterating the pouch of Douglas using permanent sutures through the uterosacral ligaments to prevent enterocele. Still performed and taught today.[17]
First Synthetic Mesh in Pelvic Floor Surgery (1955)
Moore, Armstrong, and Wills (1955) described the use of tantalum mesh to repair cystoceles combined with Kelly plication — the first reported use of synthetic mesh in pelvic floor surgery. Erosion was noted but not considered serious. Tantalum was ultimately abandoned due to metal fatigue, corrosion, and fragmentation. This obscure report was the harbinger of a controversy that would not fully erupt for another half century.[18]
Late 20th Century: The Surgical Proliferation Era
Burch Colposuspension (1961)
John C. Burch (1961) described a modification of the MMK procedure in which the paravaginal fascia is sutured not to the pubic periosteum but to Cooper's ligament (the iliopectineal ligament). This modification simultaneously corrected incontinence and cystocele while eliminating the risk of osteitis pubis. The Burch colposuspension remained the gold standard for SUI surgery for approximately 40 years — until the TVT displaced it in the late 1990s.[19]
Pereyra Needle Suspension (1959)
Armand J. Pereyra (1959) introduced a simplified transvaginal needle suspension of the bladder neck, avoiding retropubic dissection. Modified extensively over two decades, the Modified Pereyra Procedure became widely adopted by gynecologists who preferred a vaginal approach. Subsequent modifications by Stamey (endoscopic bladder neck suspension, 1973) and Raz (helical sutures, UCLA 1981) proliferated the needle suspension approach.[20]
Sacrospinous Ligament Fixation (1958–1971)
Sedera (1958) first described the sacrospinous ligament as an anchor for prolapse repair. Richter (Germany, 1968) formalized vaginal sacrospinous ligament fixation. Randall and Nichols (USA, 1971) published the first American series of transvaginal sacrospinous ligament fixation, establishing the technique in the United States.[21]
McGuire and Lytton — Autologous Sling Standardized (1978)
Edward McGuire and Lytton (1978) standardized the autologous rectus fascia pubovaginal sling, reporting 80% success and establishing its role for intrinsic sphincter deficiency — the most severe form of SUI. The autologous fascial sling remains the most durable and reliable option for this indication today.[22]
DeLancey's Three Levels of Vaginal Support (1992–1994)
A paradigm-shifting anatomical framework from John O.L. DeLancey (University of Michigan):
- Level I: Apical suspension via the uterosacral/cardinal ligament complex to the pelvic sidewall and sacrum
- Level II: Lateral attachment of the vaginal walls to the arcus tendineus fasciae pelvis (ATFP) — paravaginal support
- Level III: Distal fusion of the vagina with the levator ani muscles, perineal membrane, and perineal body
DeLancey's three-level framework became the conceptual basis for site-specific repair and rational surgical planning.[23]
He also published the hammock hypothesis of continence (1994) — proposing that the urethra is compressed against a suburethral hammock of anterior vaginal wall and endopelvic fascia during stress — which provided the anatomical rationale for the midurethral sling.[24]
International Continence Society Founded (1971)
Eric Glen (1971) founded the ICS (originally the "Continent Club") in Exeter, UK, with an inaugural meeting of 60 participants. The ICS grew to ~3,000 members from 80+ countries and established the standardized terminology and classification systems foundational to all urogynecological research.[25]
POP-Q Classification System (1995–1996)
Bump RC and colleagues published the Pelvic Organ Prolapse Quantification (POP-Q) system in 1996 — a standardized, objective, site-specific grading system using nine measured points with the hymen as a fixed reference. Approved by the ICS (1995), AUGS (January 1996), and SGS (March 1996), POP-Q superseded the Baden-Walker system as the international research and clinical standard.[26]
The TVT Revolution (1990–1998)
Integral Theory of Continence — Petros and Ulmsten (1990)
Peter E. Papa Petros (Royal Perth Hospital, Australia) and Ulf I. Ulmsten (Uppsala University, Sweden) published "An Integral Theory of Female Urinary Incontinence" in Acta Obstetrica et Gynecologica Scandinavica Supplementum (1990). The theory proposed that:
- Continence is maintained by two directional muscle forces acting on the mid-urethra at the level of the pubourethral ligament (PUL)
- Lax PULs are the primary anatomical cause of SUI and urgency incontinence
- Restoration of PUL function via a suburethral support would restore continence
The practical application: a tension-free tape supporting the mid-urethra.[27]
Tension-Free Vaginal Tape (TVT) — Ulmsten (1996)
Ulf Ulmsten and colleagues published the first clinical description of the Tension-Free Vaginal Tape (TVT) in International Urogynecology Journal in 1996 — a thin polypropylene mesh tape passed via two small suprapubic stab incisions, placed tension-free beneath the mid-urethra, and fixed by tissue ingrowth rather than suture.
The TVT changed SUI surgery more profoundly than any procedure since the Burch colposuspension:
- Minimally invasive: Day-case procedure under local or spinal anesthesia
- Reproducible: Rapid adoption globally; no specialized training required
- Effective: Long-term success rates of 80–90% comparable to the open Burch
- Mechanism: Mid-urethral support under stress, not bladder neck suspension
The TRANSOBTURATOR TAPE (TOT) was subsequently described by Delorme (2001) to further reduce bladder perforation risk by passing the tape through the obturator foramen. TVTO (inside-out obturator approach) was described by de Leval (2003).[28]
The Mesh Controversy (2000–Present)
Synthetic Mesh Prolapse Kits (2000s)
Following the TVT's success, the pelvic mesh market expanded aggressively in the 2000s. The FDA approved commercial transvaginal mesh kits for prolapse repair in 2002, and industry rapidly developed proprietary systems:
| Device | Manufacturer | Compartment | Era |
|---|---|---|---|
| Prolift | Gynecare/J&J | Anterior/posterior/total | 2005 |
| Perigee | AMS | Anterior | 2004 |
| Apogee | AMS | Posterior | 2004 |
| Elevate | AMS | Anterior/apical | 2008 |
| Capio | Boston Scientific | Apical suspension | 2000s |
These products promised tension-free prolapse repair without autologous tissue harvest and with reduced operating time. However, post-marketing surveillance revealed high rates of mesh erosion/exposure (10–20%), dyspareunia, chronic pelvic pain, and mesh contraction — complications that proved difficult to treat and in some cases irreversible.
FDA Regulatory Action (2008–2019)
- 2002: FDA approves transvaginal mesh kits for POP — treated as 510(k) clearances ("substantially equivalent" to predicate devices) rather than requiring new clinical trials
- 2008: FDA issued its first Public Health Notification regarding serious complications of surgical mesh for POP — the first federal acknowledgment of the problem
- 2011: FDA upgraded to a Safety Communication, reclassifying transvaginal mesh for POP as a Class III (high-risk) device requiring new safety and efficacy trials
- 2016: FDA mandated post-market surveillance studies from remaining manufacturers
- 2019: FDA ordered manufacturers to stop selling all transvaginal mesh for POP repair in the United States — the most comprehensive medical device withdrawal since the Dalkon Shield
- Australia, UK, Scotland, New Zealand, and Canada implemented similar restrictions or outright bans between 2017–2020
- Cumberlege Review (UK, 2020) — "First Do No Harm" — found systemic failures in post-market surveillance and dismissed patient safety concerns, calling for a national patient registry and compensation scheme
The midurethral sling (TVT and TOT for SUI) was never banned and remained FDA-approved, drawing the regulatory distinction between mesh for prolapse repair and mesh for incontinence.[29]
:::note Regulatory Precedent The transvaginal mesh crisis fundamentally changed how medical devices are evaluated. The 510(k) clearance pathway — which allowed mesh kits to market without clinical trials based on "substantial equivalence" to a 1955 tantalum mesh paper — was exposed as wholly inadequate for implanted mesh devices. The FDA subsequently strengthened premarket approval requirements for high-risk implants. :::
The Native Tissue Renaissance
In response to mesh complications, native tissue repairs experienced renewed interest: the Manchester repair, sacrospinous ligament fixation, and high uterosacral ligament suspension were re-evaluated in comparative trials. Long-term data confirmed that while native tissue repairs carry higher anatomical recurrence rates, they avoid the specific morbidity of mesh exposure.
The Specialty of Urogynecology
Hamlin Fistula Hospital (1959–Present)
Alongside the surgical advances occurring in academic centers, one of the most consequential contributions to obstetric fistula care came from Ethiopia. Reginald Hamlin (1914–1993) and Catherine Hamlin (1924–2020), two Australian obstetricians, arrived in Addis Ababa in 1959 as short-term hospital consultants and never left.
Confronted by enormous numbers of young women with devastating obstetric fistulas — rendered incontinent, ostracized, and often abandoned — they dedicated their careers to fistula repair. The Addis Ababa Fistula Hospital was formally founded in 1974, growing into the world's largest and most specialized fistula treatment center. By the time of Catherine Hamlin's death in March 2020 at age 95, the hospital had treated over 70,000 women, with a reported success rate of approximately 93% at a cost of roughly $180 per repair.
The Hamlins established a nationwide fistula training program, trained Ethiopian surgeons, and founded the Hamlin College of Midwives to address the root cause. Catherine Hamlin was nominated for the Nobel Peace Prize and received numerous international honors. Her memoir The Hospital by the River (2001) brought global attention to the ongoing obstetric fistula crisis in sub-Saharan Africa.[33]
:::note Global Fistula Burden The WHO estimates that 50,000–100,000 new obstetric fistulas occur globally each year, with a backlog of 2–3 million untreated cases — almost entirely in sub-Saharan Africa and South Asia. The persistence of obstetric fistula is directly linked to lack of access to cesarean delivery. :::
American Urogynecologic Society (AUGS) — Founded 1979
The formal subspecialty of urogynecology began in a California living room. In 1979, five physicians met in Orange County, California, to found a new society dedicated to the clinical and surgical management of female pelvic floor disorders:
- Donald R. Ostergard (Harbor-UCLA Medical Center) — regarded as the primary organizer
- Gordon Robertson
- Mike Wiggins
- James Fuller
- Anders Jansen
They initially named the organization the Gynecologic Urology Society (GUS) — a deliberately inclusive name reflecting both gynecologic and urologic membership. The term "urogynecology" itself was coined by Swedish physician Dr. Axel Ingelman-Sundberg in 1982 as a descriptor of the clinical overlap between gynecology and urology in the care of women with lower urinary tract dysfunction.
The GUS was renamed the American Urogynecologic Society (AUGS) in 1986, reflecting its growing membership and broader clinical scope. AUGS grew into the world's largest professional society dedicated to female pelvic medicine.[34]
Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Board Certification
| Year | Milestone |
|---|---|
| 1979 | GUS (Gynecologic Urology Society) founded in Orange County, CA |
| 1982 | Term "urogynecology" coined by Axel Ingelman-Sundberg |
| 1986 | GUS renamed American Urogynecologic Society (AUGS) |
| 2000 | FPMRS (Female Pelvic Medicine and Reconstructive Surgery) adopted as specialty name |
| 2011 | American Board of Medical Specialties (ABMS) recognizes FPMRS as an official subspecialty |
| 2013 | First FPMRS board certification examinations administered jointly by ABOG and ABU |
| 2023 | Subspecialty renamed Urogynecology and Reconstructive Pelvic Surgery (URPS) by ABOG/ABU |
The joint ABOG/ABU certification in FPMRS — the first joint subspecialty certification in American medicine — formalized what practitioners had been doing for decades and created a common training framework for gynecologists and urologists. The 2023 renaming to URPS was intended to reflect the scope of the specialty more accurately while avoiding the "gynecology-only" implication of the prior name.[30]
Chronological Timeline
| Year | Milestone |
|---|---|
| c. 2050 BCE | Mummy of Henhenit — earliest known VVF case (11th dynasty Egypt) |
| c. 1835 BCE | Kahun Gynaecological Papyrus — earliest textual description of prolapse |
| c. 1550 BCE | Ebers Papyrus — additional gynecological treatments |
| 460–370 BCE | Hippocrates — pomegranate pessaries; succussion for prolapse |
| c. 98–138 CE | Soranus of Ephesus — astringent pessaries; excision of gangrenous prolapsed tissue |
| 1025 CE | Avicenna — first description of VVF in Canon of Medicine |
| 1543 | Vesalius — first accurate female pelvic anatomy in De Humani Corporis Fabrica |
| c. 1560 | Ambroise Paré — first purpose-made brass/cork pessaries with retrieval threads |
| 1844 | Charles Goodyear vulcanized rubber patent → modern pessary design |
| 1867 | Neugebauer — first partial colpocleisis (unpublished until 1881) |
| 1849 | Sims — first successful VVF repair series (Anarcha, Betsey, Lucy); silver wire sutures |
| 1852 | Sims — "On the Treatment of Vesico-Vaginal Fistula," Am J Med Sci |
| 1877 | LeFort — colpocleisis described; remains in use today |
| 1886 | Olshausen — first laparotomy for uterine ventrofixation (abdominal approach) |
| 1888 | Donald — first Manchester repair (cervical amputation + colporrhaphy) |
| 1893 | Howard Kelly — invents the air cystoscope (direct bladder visualization in women) |
| 1895 | Mackenrodt — describes the cardinal ligament (Mackenrodt's ligament) |
| 1907 | Von Giordano — first sling procedure (gracilis muscle) |
| 1908 | Fothergill — cardinal ligament plication modification → Manchester-Fothergill repair |
| 1910 | Goebell — pyramidalis muscle suburethral procedure |
| 1913 | Howard Kelly — Kelly plication stitch for SUI |
| 1917 | Stoeckel — finalizes Goebell-Frangenheim-Stoeckel musculofascial sling technique |
| 1942 | Aldridge — rectus fascia pubovaginal sling (autologous fascial sling) |
| 1946 | Te Linde — Operative Gynecology, 1st edition |
| 1949 | Marshall, Marchetti, Krantz — first retropubic bladder neck suspension (MMK) |
| 1955 | Moore, Armstrong, Wills — tantalum mesh for cystocele (first synthetic mesh in pelvic surgery) |
| 1957 | McCall — posterior culdoplasty during vaginal hysterectomy |
| 1958 | Sedera — first describes sacrospinous ligament as anchor for prolapse |
| 1959 | Pereyra — transvaginal needle suspension |
| 1959 | Reginald and Catherine Hamlin arrive in Addis Ababa |
| 1961 | Burch — Cooper's ligament colposuspension |
| 1962 | Lane — first abdominal sacrocolpopexy (4 patients) |
| 1968 | Richter (Germany) — formalizes sacrospinous ligament fixation |
| 1971 | ICS founded by Eric Glen in Exeter, UK |
| 1971 | Randall and Nichols — first American sacrospinous ligament fixation series |
| 1973 | Stamey — endoscopic bladder neck suspension |
| 1974 | Addis Ababa Fistula Hospital formally founded by the Hamlins |
| 1978 | McGuire & Lytton — autologous rectus fascia pubovaginal sling standardized |
| 1979 | GUS (Gynecologic Urology Society) founded in Orange County, CA |
| 1981 | Raz — helical suture modification of Pereyra procedure |
| 1982 | Term "urogynecology" coined by Axel Ingelman-Sundberg |
| 1986 | GUS renamed American Urogynecologic Society (AUGS) |
| 1990 | Petros & Ulmsten — Integral Theory of female urinary incontinence |
| 1992 | DeLancey — Three Levels of Vaginal Support |
| 1994 | DeLancey — hammock hypothesis of continence |
| 1994 | Nezhat CH/F/C — first laparoscopic sacrocolpopexy |
| 1995–1996 | POP-Q classification published and adopted by ICS/AUGS/SGS |
| 1996 | Ulmsten — TVT (Tension-Free Vaginal Tape) first published |
| 2000 | FPMRS adopted as specialty name |
| 2001 | Delorme — transobturator tape (TOT) |
| 2002 | FDA approves commercial transvaginal mesh kits for prolapse (510(k)) |
| 2003 | de Leval — TVTO (inside-out obturator approach) |
| 2004 | Di Marco et al. — first robotic sacrocolpopexy |
| 2005 | FDA approves da Vinci for gynecologic surgery |
| 2008 | FDA first Public Health Notification on mesh complications |
| 2011 | FDA Safety Communication; Class III reclassification; ABMS recognizes FPMRS |
| 2013 | First FPMRS board certification examinations |
| 2019 | FDA orders manufacturers to halt all transvaginal mesh for POP |
| 2020 | UK Cumberlege Review: "First Do No Harm" — systemic failures in mesh surveillance |
| 2020 | Catherine Hamlin dies, age 95 |
| 2023 | FPMRS renamed Urogynecology and Reconstructive Pelvic Surgery (URPS) |
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