Needle bladder neck suspensions (modified pereyra and stamey type) have been used for a long time with success up to 80% . They are invasive , have many complications and need regional anesthesia at best.
Barbed threads are used in cosmetic facial procedures to lift the cheeks ,neck and eye brows.
We use barbed threads in our center for cosmetic purposes and came up with a new procedure to lift the urethra in an inverted needle insertion technique using the anchorage at the pre pubic periostium.

Patients with stress urinary incontinence have been selected after their clinical assessment ,questionare and urinary voiding charts and consented to have a BNT.
All patients where informed that this is a new pilot study using barb threads instead of the mesh (TVT or TOT) to treat their SUI. They  where also aware of the similarity with the pereyra procedure and its published success rates.
The threads where placed in a semi sterile operating room at our center under local anesthesia as shown in the video.
We chose the  Bidirectional barb threads to have a better anchorage at each side of the distal urethra totally avoiding any passage under the urethral tissue therefore bypassing all complications like erosions and urinary retention. The prepubic placement avoids bladder injuries and the need for cystoscopy.

BNT seems very promising.
On the first 10 cases that we performed we have had no complications and all patients have reported major improvement in their continence.
3 out of ten patients reported pubic and vulvar discomfort that resolved in a few weeks.

This new procedure is simple effective  and seems very successful as the barb threads stay in place and their anchors do lift the urethra to its original place.
At one year we do not have any recurring patients and in our opinion a BNT can be added to our armamentarium for mild and moderate S U I.
More cases are needed to check for the longevity and the fibrosis that keep the patients continent.