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AdVance Male Sling: Pre-Operative Pad Weight as a Predictor of Surgical Outcome
Casey Kowalik, MD, Christopher W. Lebeis, MD, Arthur P. Mourtzinos, MD, MBA.
Lahey Hospital & Medical Center, Burlington, MA, USA.

Background: The AdVance male sling has been advocated for use in patients with mild to moderate urinary incontinence. Gererally, AdVance sling has not been recommended in patients with severe urinary incontinence (24-hour pad usage ≥6 per day or pad weight ≥400 grams). The aim of this study is to determine whether pre-operative pad weight is an indicator of surgical outcome.
Methods: We prospectively evaluated patients undergoing placement of an AdVance male sling for urinary incontinence following prostate surgery. 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. Patients were assessed by pad count, pad weight, and self-assessment through IIQ and UDI scores at baseline and during follow-up, as well as reporting a percentage improvement following surgery.
Results: We identified 56 patients from our database, but 1 patient was excluded as no post-operative pad weight was available. Median follow-up was 33 months. Pre-operativley, 21 patients (38%) had a pad weight 0-100 grams (g), 21 (38%) had pad weight between 101-200g, 9 (16%) with pad weight between 201-300g, and 4 patients (7%) with pad weight >300g. Of the 21 patients with pad weight <100g, 95% (n=20) were cured following sling placement. Of the patients not cured, median pre-operative pad weight was 252g versus 98g in those who were cured. The likelihood of sling failure increased significantly with pre-operative pad weight exceeding 200g (p=0.0067) with a 54% failure rate (7/13). In patients with pre-operative pad weights >200g, post-operative IIQ and UDI scores were significantly different from patients with pad weight <200g with p=0.02 and p=0.01, respectively. Patient reported percentage of improvement was also significantly different between patients with pad weight <200g and those with pad weight >200g (p=0.02). Five of the 13 patients with pre-operative pad weights >200 grams went on to have salvage procedure compared to 1 patient in the group with pad weight <200g.
Conclusion: Patients with pad weight >200g were more likely to fail and reported less subjective improvement compared to patients with pad weight <200g. When offering the AdVance male sling to patients with pre-operative pad weight >200 grams, patients should be counseled regarding the increased rate of failure.
Table 1. Outcomes following AdVance sling
Pre-operative pad weight (grams)Total patientsCureImprovementFailure
0-100212001
101-200211443
201-3009315
>3004202


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