Stress urinary incontinence (SUI) and lower urinary tract symptoms (LUTS) significantly impact women's quality of life (QoL), including sexual health, with >50% experiencing female sexual dysfunction (FSD). This study aims to evaluate the efficacy and safety of the Altis® single-incision sling (SIS) for SUI. Additionally, it examines changes in sexual function after surgery, identifying clinical and ultrasonographic parameters potentially associated with improvement during follow-up.

This retrospective, monocentric study includes female patients who underwent SUI correction with the Altis® SIS. We collected data on medical history, LUTS, clinical assessments, urodynamic parameters, and questionnaires (ICIQ-SF,FSFI,FSDS,IFCI-Q,PGI-I). Surgical aspects and intra- or perioperative complications were reported. Follow-up evaluations included clinical and LUTS assessment at 1 month after surgery and pelvic floor ultrasound (US) examinations at 6 months.

A total of 71 patients (mean age 59.9 ± 12.3 years) were included. The mean operative time was 25±7 minutes without intraoperative complications. 7% experienced acute urinary retention requiring temporary catheterization. At 1-month follow-up, significant improvements in LUTS and QoL were observed, with a 91.1% reduction in positive stress tests and a high PGI-I score (median 2). At the 6-month follow-up, 35 patients were re-evaluated. Among sexually active patients (n=23), a significant improvement in FSFI and FSDS scores was noted, despite a persistence of dyspareunia in 9 cases. Clinical and ultrasound parameters did not significantly differ between patients with and without postoperative FSD, except for a higher prevalence of pelvic floor overactivity (PFO) in pre- and postoperative evaluation in those reporting dyspareunia.

Our study confirms the efficacy and safety of the Altis® SIS for the surgical treatment of SUI. At short-term follow-up, patients demonstrated significant improvements in LUTS, as evidenced by the reduction in positive stress tests and a high PGI-I score. Regarding sexual function, a significant improvement in FSFI and FSDS scores among sexually active patients were observed, suggesting that SUI correction has a positive impact on female sexual health. However, 17.4% of patients reported dyspareunia postoperatively. Clinical and US evaluations did not reveal significant differences in SIS positioning, except for a higher prevalence of PFO at clinical examination, in those symptomatic. This suggests that pelvic floor dysfunction, present in pre and postoperative evaluation in this group, may play a key role in sexual discomfort.

The Altis® SIS represents a safe and effective surgical approach for SUI, demonstrating high patient satisfaction and improvements in sexual function. The occurrence of postoperative dyspareunia, regardless of the type of surgery, underscores the necessity for further research on patient selection and rehabilitation strategies to optimize sexual outcomes.