Parent Page: Academic Departments id: 31563 Active Page: TD12id:31571


3-D Ultrasound Localization of Altis Single Incision Slings

Resident: Linh Do, MD

Faculty Advisor: Lieschen Quiroz, MD


Background: Slings for the surgical treatment of stress urinary incontinence (SUI) include retropubic midurethral sling, trans-obturator sling, or single incision midurethral sling (SIMS). There is limited data explaining potential causes of sling failures. Possible failure may be related to the positioning of the sling relative to the mid urethra.

Objective: In this study we used 3-Dimensional endovaginal ultrasound (3-D EVUS) to measure sling location at baseline (intra-operatively) and compared it to 3 months follow up. We also assessed interval symptom improvement and patient satisfaction


This was a single center, prospective cohort pilot study. We enrolled patients with planned Altis® (Coloplast, Minneapolis MN) SIMS for the treatment of SUI. A 3-D EVUS was performed at baseline and at 3 months postoperative visit. Measurements included: urethral length (distance from UVJ to the urethral meatus) and distance from the UVJ to the leading proximal edge of the sling. Validated surveys included Urinary Distress Inventory (UDI-6) and Patient Global Impression of Improvement (PGI-I) were also obtained.


This was an interim analysis of 24 out of 50 participants. The mean age was 53 ± 14 years of age, mean BMI was 33.2 ± 6.6 kg/m2, and median parity was 2 (IQR 2-3). Participants had preoperative prolapse of stage I (33.3%) and stage II (42.9%). The three most common procedures performed included apical suspension (uterosacral ligament suspension or sacrocolpopexy), 50%, posterior colporrhaphy, 54.6%, and anterior colporrhaphy, 40.9%. Average urethral length at baseline was 41.44 mm ± 3.4 and at 3 months was 39.7 mm ± 3.6. The average measurement from UVJ to the leading proximal edge of the sling was 19.8 mm ± 3.9 at baseline and 21.5 mm ± 4.8 at 3 months. The mean difference in sling position from baseline to 3 months follow up was 1.7 mm (95% CI 0.1 – 3.4, P-value = 0.04). The average UDI-6 score decreased from 54.4 to 12.7 with a P- value of < 0.0001 from baseline to 3 months follow up. In addition, the PGI-I score showed 89.5% of women reported “very much” and “much better”.


This analysis showed that there is minimal distal change in sling position at the midurethra from baseline to 3 months post-operation. SIMS position remains relatively stable after placement in the operating room.