Beyond the Mesh: PuboUrethral Ligament Plication Versus Transobturator Tape at 6 Months and the Power of Preoperative ICIQ-SF for Risk Stratification.

Abstract

<h4>Introduction and hypothesis</h4>To compare short-term outcomes of pubourethral ligament plication (PLP) versus transobturator tape (TOT) for stress urinary incontinence (SUI) and evaluate the prognostic value of the preoperative International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF).<h4>Methods</h4>In this prospective, non-randomized cohort study, 140 women underwent PLP (n = 48) or TOT (n = 92). Success was assessed at 6 months using objective (pad count) and subjective criteria. Predictive performance of preoperative ICIQ-SF was analyzed using receiver operating characteristic (ROC) curves.<h4>Results</h4>Preoperative symptoms were more severe in the TOT group (p = 0.003). Objective success rates were 88.0% for TOT and 77.1% for PLP (p > 0.05); subjective satisfaction was high and comparable. PLP had significantly shorter operative duration (p < 0.001) and no mesh-related complications, while TOT had an 8.7% complication rate. Preoperative ICIQ-SF score demonstrated excellent discriminative power for predicting failure (AUC 0.98; 95% CI 0.96-1.00), whereas daily pad count was a poor predictor (AUC 0.48). An ICIQ-SF threshold of ≥ 17 points identified patients at high risk of failure with high sensitivity and specificity.<h4>Conclusions</h4>PLP and TOT provide comparable short-term relief. PLP is a faster, mesh-free alternative avoiding synthetic material-related morbidity. Preoperative ICIQ-SF is a robust tool for individualized risk stratification, though the high AUC warrants external validation.