ULP (urethral ligament plication) and midurethral sling: identical anatomical pathways for cure of stress incontinence

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.