Tape-free pubourethral ligament plication surgery: clinical efficacy and quality of life outcomes in women with stress urinary incontinence.

OBJECTIVE: To evaluate clinical efficacy and safety of pubourethral ligament (PUL) and external urethral ligament (EUL) plication in women with stress urinary incontinence, assessing objective surgical outcomes and patient-reported quality of life. MATERIALS AND METHODS: This prospective cohort enrolled 49 women aged 35 to 70 years with stress urinary incontinence undergoing PUL and EUL plication between May 2024 and May 2025. Primary outcomes included objective cure rates via standardized stress testing and quality of life using the validated Incontinence Quality of Life (I-QOL) questionnaire at six-month follow-up. Composite success criteria integrated objective and subjective parameters. Statistical analyses included paired comparisons and multivariate logistic regression. RESULTS: At six-month evaluation, objective cure rate was 71.4% without complications. Mean operative time was 16.5 ± 3.0 min, with 46.9% same-day discharge. Total I-QOL scores improved from 51.7 ± 20.1 preoperatively to 76.4 ± 20.0 postoperatively (p < 0.001), representing 24.7-point enhancement. All subscales showed significant improvements: behavioral limitation (25.5 points), psychosocial impact (23.1 points), and social isolation (29.3 points). Composite criteria showed complete success (46.9%), partial success (42.9%), and treatment failure (10.2%). CONCLUSION: PUL and EUL plication constitutes an effective and safe technique for stress urinary incontinence secondary to urethral hypermobility, achieving substantial cure rates and meaningful improvements in quality of life. This minimally invasive ligamentous repair, which avoids synthetic mesh implantation, represents a viable alternative to conventional midurethral sling procedures, with a favorable safety profile and comparable efficacy.