1349 RE-ASSESSMENT OF SUBJECTIVE OUTCOMES OF THE ADVANCE™ SLING – INSIGHT INTO THERAPEUTIC DURABILITY

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence—Evaluation & Therapy1 Apr 20111349 RE-ASSESSMENT OF SUBJECTIVE OUTCOMES OF THE ADVANCE™ SLING – INSIGHT INTO THERAPEUTIC DURABILITY Hanhan Li, Bradley Gill, Amy Nowacki, Hadley Wood, and Sandip Vasavada Hanhan LiHanhan Li Cleveland, OH More articles by this author , Bradley GillBradley Gill Cleveland, OH More articles by this author , Amy NowackiAmy Nowacki Cleveland, OH More articles by this author , Hadley WoodHadley Wood Cleveland, OH More articles by this author , and Sandip VasavadaSandip Vasavada Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1170AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The male transobturator sling is a viable option for patients who experience mild to moderate incontinence after prostatectomy. Previous studies have demonstrated quantitative success in treating post-prostatectomy incontinence (PPI). This study focuses on the durability of patient perceived efficacy. METHODS Telephone survey and retrospective chart review were conducted on patients receiving a sling prior to 2010 by either of two surgeons at a large academic institution. Of this group, 35 patients were previously surveyed in 2008. Telephone survey included the Patient Global Impression of Improvement (PGI-I) and Severity (PGI-S) of incontinence, questions concerning pre- and post-sling pad quantity, type, and usage, and durability of sling efficacy. Patient-determined success was defined as “very much” or “much” better PPI on the PGI-I without subsequent incontinence therapies. Patients lost to follow-up were analyzed as failures. RESULTS A total of 67 patients (mean age 67, BMI 27) received the sling at median 23 months [Q1–Q3: 14–90] post-prostatectomy. PPI treatments included Kegel exercises (27%), external clamp (7%), anticholinergics (25%), collagen (12%), durasphere (4%), bone-anchored sling (1%), and artificial urinary sphincter (AUS) (7%). Per chart, a mean 2.8 (SD 2.3) pads were used daily pre-sling. Telephone follow-up was successful in 58 (87%) patients at a mean of 23 months post-sling. Patients reported improvement in PPI as “very much” (41%), “much” (19%), and “a little” (14%) better. Of the rest, 16% reported “no change” or worsening PPI as “a little” (3%), “much” (5%), and “very much” (2%) worse. Pad usage post-sling decreased from 3 to 1.5 (p<0.0001). For patients whose post-sling improvement worsened over time (n=20), only one felt something “tear” or “pull” after surgery. Men who responded to both surveys (n=23) with mean follow-up at 9 and 31 months post-sling reported an increase in daily pad use from 1.3 to 2.1 (p=0.03). A total of 15 (22%) patients sought additional incontinence therapies: bulking injections (4), AUS (4), external clamps (4), exercises (3), medications (2), and acupuncture (1). Overall patient-determined success rate, as defined, was 43%. Patients new to this second study had success at first follow-up (53%) similar to those previously assessed, who now show reduced (32%) patient-perceived effectiveness. CONCLUSIONS Most patients receiving the AdVance™ sling do see improvement in PPI and a decrease in pad usage but durability of perceived benefit decreases over time, requiring some patients to seek further therapies. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e539 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hanhan Li Cleveland, OH More articles by this author Bradley Gill Cleveland, OH More articles by this author Amy Nowacki Cleveland, OH More articles by this author Hadley Wood Cleveland, OH More articles by this author Sandip Vasavada Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...