The ULP (urethral ligament plication) operation for stress urinary incontinence is based on the same anatomical etiopathogenesis as the midurethral sling (MUS): restoring collagen to weakened PULs (pubourethral ligaments), albeit, by plication with collagenopoietic wide-bore polyester sutures to prevent PUL elongation under stress. Calculated collagenopoietic sufficiency of polyester sutures came from a doctoral thesis where collagen strength from a rejected polyester graft was tested. Precise placements of the single polyester suture to PUL were based on a live anatomical study. 12-month cure rate was 83% (learning curve included), with no post-operative urinary retention, due to absence of suburethral tapes.

VIDEO ABSTRACT provides an anatomical summary of the PPP operation. A technique for the pubourethral plication procedure (PPP) with No3 polyester sutures for cure of stress urinary incontinence without tapes via parallel sulcal incisions extending from bladder neck to urethral meatus. Both branches of each pubourethral ligament were sutured with No2 or 3 polyester sutures extending to the external urethral ligaments and medial part of pubococcygeus; the vaginal incisions closed with polyglactin sutures. All women were discharged of day of surgery. Six month results Age :58.6 years;31/36 women (86%)were cured of SUI and 11/19 (58%) concomitant urge. 5 surgical failures, 4 immediately post-operatively, and one at 3 months.