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AdVance Transobturator Sling for Post-Prostatectomy Incontinence: Effects of Radiation and Duration of Follow-Up On Efficacy and Patient Satisfaction
Daniel Marchalik1, Henry Collier Wright, IV1, Lee A Richter2, Amanda Pysher1, Keith Kowalczyk1, Gaurav Bandi1, Jonathan Hwang1, Kevin McGeagh1 1MedStar Georgetown University Hospital, washington, DC;2MedStar Washington Hospital Center, washington, DC
Introduction: The efficacy of the AdVance transobturator male sling for post-prostatectomy incontinence has been questioned in patients with a history of pelvic radiation. Furthermore, there exists limited data on long-term follow-up and durability of this procedure. Materials & Methods: We performed a retrospective chart review and follow-up surveys of all patients who underwent a post-prostatectomy sling placement for urinary incontinence from 2007 to present. Severity of urinary incontinence was determined by PPD use. Patient satisfaction was determined by willingness to recommend the procedure to a friend. Outcomes were compared between radiated and non-radiated men at both short-term and long-term follow-up intervals. Results: Fifty-two men underwent AdVance Sling placement at our institution from 2007 to present; 18 men had a history of adjuvant radiation. Thirty-six and 16 men were available for short-term (mean 19.4mo) and long-term (mean 61.5 mo) postoperative interviews, respectively. Overall, PPD use improvement was seen in both groups. However, patient satisfaction and efficacy decreased with time in both groups, to a much greater degree in radiated patients (Table 1). Conclusions: The majority of patients undergoing AdVance sling placement for post-prostatectomy incontinence saw a reduction in PPD use, and were overall satisfied in both groups at short- and long-term follow-up. The improvements were more pronounced in the non-radiated group. Therefore, the AdVance sling is markedly a more efficacious and durable intervention in radiation-naive patients.
| Radiation (n=14) | Non-Radiation (n=22) | P Value | Short-Term Improvement in PPD | 1.1 (3 to 1.9ppd) | 2.3 (3.3 to 1ppd) | <0.05 | Short-Term Patient Satisfaction | 64% | 95% | | | Radiation (n=6) | Non-Radiation (n=10) | | Long-Term Improvement in PPD | 0.8 (3 to 2.2) | 1.55 (3.3 to 1.75) | 0.09 | Long-Term Patient Satisfaction | 33% | 80% | |
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