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The AdVance Transobturator Male Sling for Postprostatectomy Incontinence: clinical results of a prospective evaluation utilizing patient-driven questionnaires
Justin Gould, MD, John Stoffel, MD, Arthur Mourtzinos, MD.
Lahey Clinic Medical Center, Burlington, MA, USA.

BACKGROUND: Although surgical techniques for radical prostatectomy (RP) have been refined, a significant number of patients, even in minor or moderate degrees, suffer from persistent postprostatectomy stress urinary incontinence (SUI). Transobturator male slings have been proposed to manage SUI after prostate surgery, but data are still lacking. The AdVance male sling is a treatment option for SUI, with the goal of eliminating urinary incontinence without affecting voiding parameters. The purpose of this study was to prospectively evaluate the clinical outcome after management of SUI after prostatic surgery by placement of an AdVance male sling.
METHODS: We conducted a prospective evaluation 45 patients treated in a single center between February 2008 and January 2010 for mild to moderate SUI following prostatic surgery with an AdVance male sling. The etiology was post-prostatectomy in 43 patients, external beam radiation therapy in 1 patient, and a laser transurethral resection of the prostate (TURP) in 1 patient. Five patients had received adjuvant radiation therapy. Eight patients had failed prior urethral bulking procedures. The surgical outcome was determined by clinical history and physical examination and, primarily, by patient self-assessment and included validated symptom, bother, and quality-of-life questionnaires.
RESULTS: Of the 45 patients, 30 no longer wear any pads and have no incontinence, 10 were improved, and 5 had no improvement. Previous radiation therapy was associated with a slightly higher risk of failure. Of the 10 who were improved, 2 patients subsequently chose to have an artificial urinary sphincter (AUS) placed and are now totally continent. One patient who had significant improvement and was using greater than >6 pads/day elected to proceed with a second type of sling as a salvage procedure. Of the 5 patients who had no improvement, one underwent placement of an AUS and is totally continent. The other four are contemplating either placement of a different type of perineal sling or an AUS. Over 85% of patients reported subjective improvement in their overall quality of life.
All patients were catheterized for 24 hours. Four patients developed post-operative urinary retention requiring discharge with a urethral catheter for 3 days. Two patients required clean intermittent catheterization for 1 and 3 weeks respectively. One patient who had no improvement in his symptoms had unresolving scrotal pain requiring further surgical therapy.CONCLUSIONS: Placement of an AdVance male sling is a safe and effective procedure for mild to moderate incontinence. Placement of an AdVance sling does not preclude the later placement of other types of perineal slings or an AUS in patients who do not achieve desired results. Further evaluation and high-quality controlled, randomized studies are needed to assess long-term efficacy and precise indications of this procedure for post-prostatic-surgery SUI management.


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