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The AdVance transobturator male sling for post-prostatectomy incontinence: patient-perceived outcome with at least 3 years follow up.
Jessica DeLong, MD, Casey Kowalik, MD, Arthur Mourtzinos, MD.
The Lahey Clinic, Burlington, MA, USA.
BACKGROUND: Transobturator male slings have been proposed to manage stress urinary incontinence (SUI) after prostate surgery, but long term 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 objective of this study was to determine patient-perceived outcomes of the AdVance sling with at least 3 years follow-up.
METHODS: We conducted a prospective evaluation of 24 patients treated by a single surgeon between February 2008 and January 2009 for mild to moderate SUI following radical prostatectomy with an AdVance male sling. Two patients had received adjuvant radiation therapy, and 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, including validated symptom, bother, and quality-of-life questionnaires.
RESULTS: Of the 24 patients, 14 no longer wore any pads and have no incontinence, 8 were improved, and 2 had no improvement. Previous radiation therapy was associated with a slightly higher risk of failure. Of the 8 who improved, 3 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 2 patients who had no improvement, one underwent placement of an AUS and is totally continent. The other patient is 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. No patients worsened.
All patients were catheterized for 24 hours. Eight 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 post prostatectomy 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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