A Modified Altis® Mid-Urethral Sling That Allows Immediate Post-operative Adjustment: Experience in 197 Patients

Proper tensioning of a mid-urethral sling during surgery is critically important. An excessively tight sling can result urinary retention on one end, while a loose sling can lead to persistent stress incontinence on the other. Either situation is less than ideal and can cause much distress to both the patient and the surgeon.

Our modified technique for the Altis® Single Incision Sling System allows the surgeon to adjust the sling postoperatively for about 2 weeks in the office. The keystone of this procedure is easy access to the tensioning suture by delivering it through the vaginal incision before closure. One or more tensioning adjustments may be made to the sling within the first 2 weeks post-operatively before scarring occurs.

Overall, results from this retrospective analysis of 197 women receiving the Altis® sling were encouraging. About 16% of patients required post-operative adjustment with a majority of that group requiring a tighter sling. All these patients were able to have their sling tightened in the office. Because immediate post-operative sling tightening is so easy in office we observed that we have placed our slings more and more loosely.

This novel approach to the Altis® sling may be another “tool in the toolbox” for surgeons when considering correct sling tensioning. Our results open up numerous opportunities in future research such as long-term outcomes, complications, and patient satisfaction.

Written by: Brett J. Friedman,¹ Jennifer Nguyen,² Annah Vollstedt,² Mireya Diaz,³ Ly Hoang Roberts,⁴ Larry T. Sirls⁴

Oakland University William Beaumont School of Medicine, Rochester, MI, USA
Department of Urology, University of Iowa, Iowa City, IA, USA
Independent Consultant, Portage, MI, USA
Department of Urology, Beaumont Health System, Royal Oak, MI, USA

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