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Background: Post-prostatectomy incontinence significantly impacts quality of life by causing functional limitations and emotional distress in men. Therefore, both objective and quality of life measures should be assessed when evaluating outcomes. Our goal was to evaluate outcomes through clinical data and patient self-assessment following placement of the AdVance male sling for urinary incontinence after prostate surgery.
Methods: We conducted a prospective evaluation of patients who underwent implantation of the AdVance male sling by a single surgeon following prostate surgery between February 2008 and February 2012. All patients had at least one year follow-up. Twenty-four hour pad count, pad weight, and patient self-assessment through validated questionnaires (Urogenital Distress Inventory and Incontinence Impact Questionnaire) were assessed pre-operatively and during follow-up. Objective cure was defined as no pad usage or wearing one pad for security only, as it remained dry. Improvement was defined as ≥50% reduction in pad weight. Failure was defined as <50% decrease in pad weight or the need for salvage therapy.
Results: We found 56 patients meeting criteria, however, one was excluded as post-operative pad weight was not available. Of the remaining 55 patients, 21 (38%) had mild incontinence (pad weight <100g), 32 (58%) had moderate incontinence (100-400g) and 2 (4%) had severe incontinence (>400g). Median age was 66 years and median BMI was 28. Six patients had prior radiation for treatment of their prostate cancer. At a median follow-up of 33 months, 39 patients (71%) were cured, 5 patients (9%) improved, and 11 patients (20%) failed. Average patient-reported subjective improvement was 83%. Objective factors associated with sling failure included pre-operative pad weight >200 g (p=0.0067) and pre-operative pad count ≥4 (p=0.0001). Based on subjective analysis, no patients reported worsening of their IIQ and UDI score. Six patients (11%) went on to have salvage procedures. Fifteen patients (27%) had transient post-operative urinary retention. Six patients (11%) had groin, scrotal, or hip pain following sling placement lasting >3 months. No slings were explanted.
Conclusion: The AdVance male sling is a safe and effective treatment for male urinary incontinence following prostate surgery. Counseling regarding patient expectations is crucial when discussing treatment options for post-prostatectomy incontinence. As data regarding the AdVance® sling evolves, precise indications for treatment of stress urinary incontinence in men are needed.