For the first time we compare the effectiveness and safety of mid-urethral sling (TOT) procedures versus the collagenic threads in women with stress urinary incontinence (SUI), and to evaluate whether this new system represents a viable minimally invasive alternative. The aims of this study were to access the impact in the Quality of life (QoL) as well as to demostrate the anatomic changes obtatined in these two procedures, using transperineal Ultrasound.

This prospective, non-randomized comparative study included 50 women with clinically
diagnosed SUI. Patients were allocated to mid-urethral sling (n=25) or Collagenic threads system
(n=25). All procedures were performed by experienced surgeons. The primary endpoint
was objective cure at 12 months, defined as absence of leakage during stress testing.
Secondary outcomes included perioperative complications and patient-reported
satisfaction. Statistical analysis was performed using Fisher’s exact test. Effect size was
expressed as absolute risk difference (RD) with 95% confidence interval.  Transperineal ultra sound (TPUS), Mindray I9, with a convex probe of 5Hz, was used to evalueted (BND, URA, RVA) and questionnaires (ICIQ-SF, Sandvik, PFDI-20, PISQ-12) were assessed preoperatively and at 12 months. Statistical significance set at p < 0.05. Transobturator slings were performed according to Delorme description(2001) and PDO threads wrere used to reinforce both urtethrpelvic and puboutrethral logaments, pre and retropubic. These procedures were carried out under local anesthesia in outpatient basis.A Foley catheter with a metallic guide inside (bayonet) is used to move the urethral upwards, avoiding urethral and bladder perforations. Besides the tips of the canula are blunt, making the procedure even safer.
Once the urethra and bladder neck are moved upwards, the threads are introduced in the previous made punctures, first in a “X” format and next is an “A” shape creating a backboard support to the urethra, similar to a sling, reinforcing the urethropelvic ligament. Next, the bayonet is removed an prepubic canulas are insert on each vaginal sulcus, finally the reropubic threadds are insered using the same orifices in the vaginal wall. no catheter is left in place.

At 12 months, objective cure was achieved in 85% (21/25) of patients in the sling group
and 90% (22/25) in the threads group. Fisher’s exact test showed no statistically
significant difference (p=1.00). The absolute risk difference was +4% (95% CI: -17% to
+25%) in favor of the collagenic threads. No major intraoperative or postoperative
complications were observed. Both groups demonstrated high patient satisfaction.

Both techniques demonstrated high efficacy and excellent safety profiles. The wide
confidence interval reflects limited statistical power but remains compatible with a
clinically meaningful benefit. The consistent numerical advantage observed with the
threads group supports further investigation.

This threads system demonstrated outcomes comparable to mid-urethral sling, with a
trend toward higher cure rates at 12 months. This minimally invasive approach may
represent a promising alternative in the surgical management of female SUI. Larger
randomized studies are warranted.

tress Urinary Incontinence: Treatment With Platelet-Rich-Plasma Injection and Placement of Polydioxanone Threads—A Pilot Study Ariel Luksenburg, MD https://orcid.org/0000-0003-0057-5472 arieluks98@gmail.com, Juan J. Barcia, MD, […], and Marco A. Pelosi, III, MD+3View all authors and affiliations Volume 39, Issue 1 https://doi.org/10.1177/0748806821998100
A Minimally Invasive, Outpatient, Office Procedure for Severe Stress Urinary Incontinence in Women: Luksenburg Systems LSG3 Ariel Luksenburg, MD https://orcid.org/0000-0003-0057-5472 arieluks98@gmail.com, Juan J. Barcia, MD, […], and Marco A. Pelosi, III, MD+4View all authors and affiliations Volume 41, Issue 4 https://doi.org/10.1177/07488068231166912
Multi material thread lifting and platelet rich plasma for urethral support a new minimally invasive procedure for the treatment of stress urinary incontinence: Preliminary report Pelviperineology 2025;44(2):50-53 DOI: 10.34057/PPj.2025.44.02.2024-7-4 Pablo Gonzalez ISAZA 1 Ariel LUKSENBURG 2 Paulo PALMA 3