Early Experience with the AdVanceTM Male Sling
Michael Poch, MD, Simone Thavaseelan, M.D., Lanna Cheuck, M.D., Kennon Miller, M.D., Joseph Renzulli II, M.D..
Brown University, Providence, RI, USA.
Background: Post prostatectomy incontinence (PPI) has been reported in the literature with large variability. The historical incidence of PPI is 2.5-87% of patients. More recent series of open and robot assisted prostatectomy have reported incidences of incontinence to be 2.5%1 and 7%2 respectively. Management options include non-surgical modalities such as pelvic floor exercises or surgical therapies. Surgical options include injection of urethral bulking agents, placement of male slings, or placement of the artificial urinary sphincter (AUS). For mild to moderate PPI, male urethral slings have emerged as a viable alternative to placement of the artificial urinary sphincter.4 The goal of our study is to report our early outcomes with the AdVanceTM male sling for urinary incontinence.
After obtaining IRB approval, we performed a retrospective chart review of patients who underwent an AdVanceTM male sling placement between 2007 - 2009. Basic demographic data as well as the etiology of the incontinence and the number of preoperative and postoperative pad use was recorded. All postoperative visits were reviewed and documented. Pad use was recorded and calculated as a change in pad use from preoperative to postoperative visit. Negative change in pad use indicates improvement whereas positive change indicates worsening of incontinence.
Data was available for a total of 20 patients (two surgeons) and the records were retrospectively reviewed. The mean age of patients at time of sling placement was 67 years (range 57 - 85). The etiology of incontinence in 13 patients was radical prostatectomy. Other causes of incontinence included EBRT (2), benign prostate surgery (4), and urethral reconstruction (1). The mean change in pad use after surgery was -0.5 (range -3 - 2) and mean follow up period was 4.7 months. For those patients with data available within the first 30 days after surgery mean pad change was -1.5 (range -3 - 0) initially and then deteriorated with a mean pad change of -0.6 at further follow up. Those patients with PPI mean change in pad use was -1.08.
The AdVanceTM male sling may provide a slight improvement in overall pad use. These changes may be more marked in patients after radical prostatectomy than other causes of incontinence. Our data also show that within the immediate postoperative period (within 30 days) continence is improved and then subsequently deteriorates which may be related to sling “slippage” as there is no anchoring mechanism for the AdVanceTM male sling as opposed to the InVanceTM male sling. Further prospective studies with larger sample sizes are necessary to evaluate the true efficacy of the the AdVance TM male sling.