Female stress urinary incontinence (SUI) is a highly prevalent disease [1]. It has a significant negative impact on quality of life and the wellbeing of female patients. Single-incision slings (SIS) have been developed to reduce patient pain and discomfort by avoiding the trajectory through the adductor muscles while keeping outcomes similar to those with a standard midurethral sling. The Altis is a new, tension-adjustable, SIS procedure for the treatment of SUI. There are limited studies on its treatment outcomes but few studies have shown good cure rate [2-3]. This study aims to describe our initial experience with the Altis Single Incision Sling (SIS) for the treatment of female Stress Urinary Incontinence (SUI), including its efficacy and safety, at one month follow up.

In this retrospective, single center study, we included 65 patents with a history of pure SUI or mixed urinary incontinence with predominantly SUI symptoms who had a positive cough stress test or urodynamic diagnosis of SUI. All patients underwent Altis Single Incision Sling between August 2017 and Oct 2018 by a single surgeon at our center. Patient characteristics such as age, races, parity, BMI, menopausal status were recorded. Patients were reviewed at 1 month post-surgery. The pre-operative parameters, intra-operative details, immediate post-operative and one month follow-up data of these patients were evaluated. Primary outcome measured includes the objective and subject cure rates, confirmed by negative stress test and patient’s reported improvement of SUI symptoms respectively post procedure. Complications studied includes intra-operative complications e.g. bladder perforation, bleeding requiring transfusion, post-operative complications e.g. pain, tape erosion, voiding disorders, infection etc.

The average age of patients was 61.2 years old and the mean parity was 2.5. 55 patients (85.9%) had previous normal vaginal delivery while 6 patients (9.4%) had previous instrumental delivery. 18 patients (27.7%) had Altis SIS surgery alone while the rest had concomitant procedures such as vaginal hysterectomy (63.1%) and pelvic floor repair (anterior repair 53.8%, posterior repair 60.0%). The average duration for Altis SIS surgery alone was 23.2 minutes with an average blood loss of 18.9 mls. There were no significant intraoperative complications such as bladder perforation or major bleeding requiring transfusion. In the 18 patients who had Altis SIS alone, 17 underwent general anaesthesia and 1 underwent regional anaesthesia. None of them developed fever postoperatively. 15 (83%) were admitted and the mean hospital stay was 1.4 ± 0.8 days. 6 (33%) of them did not require an in-dwelling catheter (IDC). For the 12 patients (67%) who had an IDC inserted, the average length of catheterization was 0.7 ± 0.5 days, as compared to the mean catheterization length of 3.5 days for all cases (including concomitant surgery). 61 out of 65 patients (93.8%) attended their 1 month follow-up appointment. Subjective cure was noted in 58 patients (95.1 %) while the remaining 3 patients (4.9%) reported improvement in symptoms. 3 patients (4.9%) reported de novo urge urinary incontinence. 1 patient had urinary tract infection while another complained of occasional left thigh discomfort. 4 patients (6.2%) had voiding difficulties post-operatively and required re-admission; 3 (4.9%) underwent tape loosening while the other (1.5%) had tape loosening followed by subsequent tape cutting. Vaginal mesh extrusion was noted in 1 patient and refashioning of the mesh was done.

The short term cure rates and perioperative complications for Altis SIS were comparable to other studies on mid-urethral sling surgery. It appears to be safe and effective. However, longer term follow up data to further evaluate outcome and complications is required and is being collected.

Based on our results, the cure rate for Altis SIS was comparable to similar studies done and has low complication rates. It is hence a safe and effective treatment for SUI.

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Jorge Dias. et. al (2014) Short-term outcomes of Altis® single-incision sling procedure for stress urinary incontinence: a prospective single-center study. Int Urogynecol J (2014) 25:1089–1095
Van Drie DM (2015) The Impact of Procedure setting on Two-Year Outcomes for the Altis Single Incision Sling for women with Stress Urinary Incontinence. J Minim Invasive Gynecol. 2015 Nov-Dec;22(6S):S243-S244