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Introduction: The Altis® transobturator sling uses a dynamic anchor on a pulley suture for intraoperative tension adjustment. Given the potential for over-tensioning seen with any sling, we have adopted a technique using the pulley suture that allows for sling tightening should stress urinary incontinence (SUI) persist in the immediate post-operative period or sling loosening if there is bladder outlet obstruction. Our objective is to describe our technique and rate of post-operative adjustment. Methods: In this single-surgeon experience, retrospective chart review, demographic and clinical data were collected on patients who had received the Altis® sling between 2014 and 2020. Descriptive statistics were used. Results: 197 patients underwent the Altis® sling placement. Eighty-three percent (165/197) of the patients did not receive postoperative adjustment. Of the 32 patients who received post-operative adjustment, 8 (4.1%) had loosening performed and 24 (12.2%) had tightening performed at an average of 10 days post-op. All 24 tightening procedures were done in the clinic. Of the 8 patients who had post-operative loosening performed, 6 were performed in the clinic and 2 in the operating room under general anesthesia. Of these two patients, one was still an inpatient and one required an additional concomitant procedure. Conclusion: This novel Altis® sling technique provides the surgeon with the ability to tighten or loosen postoperatively depending on immediate post-operative results. Overall, in the hands of one surgeon, 16% of patients were adjusted in the post-operative period. All tightening procedures and all but two loosening procedures were performed in the clinic.


The 95th Annual Meeting of the North Central Section of the AUA, Chicago, IL, October 6-9, 2021.

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