(Poster 167) Case Series Exploring a Novel Adjustable Single-Incision Sling (ASIS) Technique

Objectives: To describe patient characteristics and short-term outcomes of patients undergoing a novel technique of post-operative adjustment of single-incision sling

Methods: All woman who underwent the ASIS technique for the treatment of stress urinary incontinence (SUI) were identified. This innovative technique enables postoperative tensioning and loosening by threading the tensioning suture, along with an additional suture positioned on the adjustable side, through the vaginal incision. Descriptive analysis was performed. Counts and percentages for categorical variables were calculated and medians and interquartile ranges were calculated for continuous variables.

Results: Fourteen patients were identified as having undergone the ASIS technique from June 2022 and February 2025. The median age of patients undergoing this procedure was 68 years old [IQR 12]. Indications for the ASIS included prior failed sling (35.71%), history of prior sling revision (14.29%), and detrusor underactivity (30.8%). Ten patients underwent a concomitant procedure (71.42%). Median estimated blood loss was 37.5 ml (IQR 68.75). A total of 5 (35.71%) patients failed a post-operative void trial on post-operative day 0 necessitating re-catheterization. Patients required a median of 3 [IQR 2.75] clinic visits following the procedure. Median follow-up time was 1.5 months [IQR 4.75]. Six patients (42.86%) did not need adjustment of sling at their post-operative visit. Six patients (42.86%) required the sling to be loosened, and 2 patients (14.29%) required their slings to be tightened at their post-operative visit. On average, patients required 1 (IQR 1) post-operative visit before cutting the adjustable sling sutures. Ten patients (71.43%) reported symptoms to be “greatly improved” on the global scale of postoperative patient satisfaction and only 1 patient (7.14%) reported to be "not improved” after surgery. No patients had objective findings of SUI at their postoperative visit and only two patients reported subjective SUI. The most common complications were transient groin pain in 3 patients (21.43%) and short-term urinary retention in 3 patients (21.43%). All cases of urinary retention resolved at subsequent visit after loosening of the sling. No major complications were identified.

Conclusions: The ASIS technique is a safe and reproducible procedure with favorable outcomes and a low complication rate. The ability to adjust the sling postoperatively offers a more personalized treatment approach for patients. Additional larger studies are needed.