AdVance Male Sling Research Articles

(037) Trans Obturator Repositioning Sling (TOROS); Novel Proximal Fixation of Penile Prosthesis Cylinder in Neophallus

Abstract Introduction The placement of Penile Prosthesis (PP) in transgender men with a neophallus is technically demanding and poses challenges specifically related to the extracorporal proximal anchoring of the cylinders owing to the lack of proximal corpora. We herein designed a novel Trans-Obtutrator Repositioning Sling (TOROS) for the proximal PP cylinder anchoring in a phallus of cisgender man or a neophallus of transgender man. Objective To assess the safety and efficacy of this novel surgical approach for the extracorporal proximal PP cylinder anchoring (TOROS) in two patients (cisgender and transgender) through refashioned use of the AdVanceTM Male Sling System (Boston Scientific). We herein present one video (first patient) to demonstrate step by step surgical technique. Methods Two patients were included. First patient is a 38-year-old cisgender male with a history of micropenis who underwent anterolateral thigh phalloplasty in 2017 presents for PP insertion. Second patient is 35 year old transgender with history of right free flap forearm phalloplasty 2019 with prior failed PP revision presents with perineal pain at level of proximal PP cylinder. Both patients consented and elected to proceed. Results After careful identification of neophallus vascular pedicle with handheld doppler, a perineal midline incision was made. The space within the neophallus was carefully dissected, dilated up to 11mm with Hegar dilator and measured for upcoming PP cylinder. Next and similar AdVance Male Sling surgical approach, the Adductor Longus tendon identified as a landmark, a trocar was inserted carefully through the obturator foramen around the inferior ischiopubic ramus. The sling was pulled via perineal incision and refashioned into socket-like sling to house the proximal end of PP cylinder or Rear Tip Extender (RTE) (in this case). To further reinforce this connection, sling flanges wrapped around and suture fixated. Next a single-cylinder Ambicor PP (Boston Sci) is inserted. PP pump placed into the left perineal side. Total PP length was 15cm+2cm RTE. PP appeared cycling well. Skin closed in layers. Patient had an uneventful post-op course and discharged on POD #3. At the 6-week mark, the patient had no post-op complaints or complications. The patient has been able to cycle the penile implant twice daily without issue and satisfied with the outcome of the procedure. Conclusions Extra-corporal anchoring of PP cylinders using TOROS is a novel, feasible and potentially changing approach in cisgender or transgender men. Proximal anchoring of the cylinders on the inferior pubic ramus and ramus of the ischium through the modified and refashioned use of trans-obturator male sling mimic natural anatomical attachment of the proximal corpora, and the same approach can applied in a transgender man neophallus with apparent good stability with and without axial loading. Disclosure No.

(185) Trans Obturator Repositioning Sling (TOROS); Novel Proximal Fixation of Penile Prosthesis Cylinder in Neophallus

Abstract Introduction The placement of Penile Prosthesis (PP) in transgender men with a neophallus is technically demanding and poses challenges specifically related to the extracorporal proximal anchoring of the cylinders owing to the lack of proximal corpora. We herein designed a novel Trans-Obtutrator Repositioning Sling (TOROS) for the proximal PP cylinder anchoring in a phallus of cisgender man or a neophallus of transgender man. Objective To assess the safety and efficacy of this novel surgical approach for the extracorporal proximal PP cylinder anchoring (TOROS) in two patients (cisgender and transgender) through refashioned use of the AdVanceTM Male Sling System (Boston Scientific). We herein present one video (first patient) to demonstrate step by step surgical technique. Methods Two patients were included. First patient is a 38-year-old cisgender male with a history of micropenis who underwent anterolateral thigh phalloplasty in 2017 presents for PP insertion. Second patient is 35 year old transgender with history of right free flap forearm phalloplasty 2019 with prior failed PP revision presents with perineal pain at level of proximal PP cylinder. Both patients consented and elected to proceed. Results After careful identification of neophallus vascular pedicle with handheld doppler, a perineal midline incision was made. The space within the neophallus was carefully dissected, dilated up to 11mm with Hegar dilator and measured for upcoming PP cylinder. Next and similar AdVance Male Sling surgical approach, the Adductor Longus tendon identified as a landmark, a trocar was inserted carefully through the obturator foramen around the inferior ischiopubic ramus. The sling was pulled via perineal incision and refashioned into socket-like sling to house the proximal end of PP cylinder or Rear Tip Extender (RTE) (in this case). To further reinforce this connection, sling flanges wrapped around and suture fixated. Next a single-cylinder Ambicor PP (Boston Sci) is inserted. PP pump placed into the left perineal side. Total PP length was 15cm+2cm RTE. PP appeared cycling well. Skin closed in layers. Patient had an uneventful post-op course and discharged on POD #3. At the 6-week mark, the patient had no post-op complaints or complications. The patient has been able to cycle the penile implant twice daily without issue and satisfied with the outcome of the procedure. Conclusions Extra-corporal anchoring of PP cylinders using TOROS is a novel, feasible and potentially changing approach in cisgender or transgender men. Proximal anchoring of the cylinders on the inferior pubic ramus and ramus of the ischium through the modified and refashioned use of trans-obturator male sling mimic natural anatomical attachment of the proximal corpora, and the same approach can applied in a transgender man neophallus with apparent good stability with and without axial loading. Disclosure No.

The AdVance Sling and Male Sexual Function: A Prospective Analysis on the Impact of Pelvic Mesh on Erectile and Orgasmic Domains in Sexually Active Men With Postprostatectomy Stress Urinary Incontinence.

BackgroundTransvaginal pelvic mesh surgery has been shown to cause female sexual dysfunction.AimTo evaluate the sexual function impact of AdVance male sling (MS) on erectile and orgasmic domains.MethodsA review of a prospectively collected database was conducted in all sexually active men who underwent AdVance MS for postprostatectomy stress urinary incontinence between 2012 and 2018.OutcomesPatient demographics, clinical outcomes, and validated questionnaires such as the Brief Male Sexual Function Inventory (BMSFI), International Index of Erectile Function (IIEF) and Patient Global Impression of Improvement (PGI-I) were reviewed at 6, 12 and 24 months.ResultsOf the total of 65 men who received AdVance sling, an increase in IIEF-5 score ≥5 points were reported in 10 (15%) patients with no patients complained of deteriorating erectile function at 24 months. The improvement in orgasmic function (Question 10 on IIEF-15) was reported in 22 (34%) patients while 3 (5%) patients reported lower orgasmic scores. The sexual domains scores in BMSFI were higher in 40 (62%) patients, especially with regards to sexual desire (Question 1 and 2) and satisfaction with sex life (Question 11). No patient reports pelvic or urethral pain. The reported improvement in erectile and orgasm scores remained similar throughout the 24-months follow-up period. All 20 patients with preoperative climacturia reported resolution of their symptoms during sexual activity. The overall PGI-I was 1.4 (1–3) and men with a higher continence rate were more likely to report better male sexual function (P = .044).Clinical implicationsAdVance MS appears to improve erectile and orgasmic domains, and there is a positive correlation between urinary continence and male sexual function.Strengths and limitationsStrengths of this study include the prospective large patient population analyzed regarding the impact of MS on male sexual function with the use of validated instruments for erectile, orgasmic, and urinary domains. Limitations include single-centre data, relatively short-term follow-up study and lack of a comparative arm.ConclusionDespite the reported adverse effect of sexual dysfunction following pelvic mesh in the female population, the AdVance PMS appears to improve male sexual function with regards to erectile and orgasm domains.Chung E, Wang J. The AdVance Sling and Male Sexual Function: A Prospective Analysis on the Impact of Pelvic Mesh on Erectile and Orgasmic Domains in Sexually Active Men With Postprostatectomy Stress Urinary Incontinence. Sex Med 2022;10:100529.

AdVance and AdVance XP Male Sling Comparison, an Institutional Experience

ABSTRACT Introduction The AdVance male sling has been used for many years for the treatment of male stress urinary incontinence with multiple previous studies evaluating its efficacy. More recently, a new generation AdVance XP was designed with modifications in its design and surgical tools in hopes to improve patient outcomes. Objective The aim of our study was to provide our institution's outcomes comparing objective and patient-reported outcomes of the AdVance male sling to the AdVance XP. Methods All patients who have had placement of an AdVanceXP male urethral sling were retrospectively reviewed. Inclusion criteria included the necessity of one year post-operative follow up. We then identified a comparative cohort who had the most recent placement of the AdVance sling. We compared patient demographics, baseline characteristics, functional outcomes, voiding studies and complications. Results A total of 11 patients who received the AdVanceXP were compared to 11 patients who received the AdVance male sling. There were no statistically significant differences in baseline demographics between the two groups (Table1). When comparing the AdVance XP to Advance, there was no difference in change in average flow rate (-1.26mL/s vs -5mL/s, p=0.476) or peak flow (-5.11mL/s vs -5.73mL/s, p=.936). Patient's pre-surgical pad usage was greater in the AdVanceXP than the AdVance sling groups (2.64 vs 1.60, p=0.019). The mean decrease in pad usage was 1.95 pads in those with the AdVanceXP compared to 1.36 pads with the AdVance (p=.227). There were no statistically significant differences in operative times between the AdVanceXP and the AdVance male sling (64.5min vs 68.8min, p=.249). Both groups had one patient who had issues with post-operative pain and neither group had any patients with post-operative retention, infection or need for reoperation within one year. Conclusions Patient's who had placement of the AdVanceXP were found to have a greater reduction in pad usage when compared to the AdVance sling, though not reaching statistical significance. Disclosure No

Five-Year Results of a Prospective Multicenter Trial: AdVance XP for Postprostatectomy-Incontinence in Patients with Favorable Prognostic Factors

Objective: The aim of this study was to assess the security, value, and efficacy of the second-generation AdVance male sling XP (Boston Scientific®), after implementation in 2010 with advantageous modifications in the sling structure and needle shape, in a prospective multicenter long-term follow-up study. Methods: In total, 115 patients were included. Exclusion criteria were earlier incontinence (UI) surgery, nocturnal UI, former radiotherapy, or night-time incontinence. We also excluded patients with a functional urethra <1 cm in a preoperatively performed repositioning test. A consistent 24-h pad test, International Quality of Life (IQOL) score, visual analog pain scale (VAS), International Consultation-Incontinence Questionnaire (ICIQ-UI SF), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), and Patient Global Impression of Improvement (PGI-I) scores were requested postoperatively. Results: The 24-month follow-up (114 patients) revealed 64.0% cured and 28.8% improved patients. Mean urine loss was reduced significantly to 19.0 g (p < 0.001). A mean PGI score of 1.5 and a mean VAS score of 0.2 were obtained. The 60-month follow-up (59 patients) revealed 57.6% cured and 25.4% improved patients. Mean urine loss was reduced significantly to 18.3 g (p < 0.001). A mean PGI score of 1.6 and a mean VAS score of 0.2 were obtained. Conclusions: The AdVance XP displays excellent continence results and secure effectiveness over a 5-year period. Moreover, these data are demonstrating low complication rates and improved quality of life in the long-term use of AdVance XP.

017 Novel Technique for Extra-Corporal Placement of Penile Prosthesis in Cis and Transgender Male: The Modified Use of Advance Male sling for Proximal Anchoring

The optimal placement of penile prosthesis (PP) in men with corporal fibrosis post ischemic priapism and prosthetic infection is technically demanding due to the difficulty of re-establishing corporal cavity and dilation. The placement of PP in transgender men with a neophallus is also technically demanding and poses challenges specifically related to the dilemma of optimal proximal anchoring of the cylinders due to absence of proximal corpora and risk of distal erosion. We have developed a novel approach in these special populations, whether it is a phallus in cisgender man or a neophallus in transgender man. To assess the feasibility of a novel surgical approach for extra-corporal (outside the corpus cavernosum) placement of PP in cisgender men, using the native phallus as a neophallus and optimal proximal anchoring of PP cylinders in cisgender man phallus and transgender man neophallus through modified use of the AdVance™ Male Sling System (Boston Scientific).

Effectiveness and Complications of the AMS AdVance™ Male Sling System for the Treatment of Stress Urinary Incontinence: A Prospective Multicenter Study

ObjectiveTo evaluate the effectiveness and tolerance of the AdVance Male Sling System for the treatment of male stress urinary incontinence in patients after prostatic surgery. MethodsAn international, observational, prospective, multicenter study was conducted on male patients with urinary incontinence after prostatic surgery. Patients underwent a 24-hour pad test with a threshold at 250 g. All patients were operated with the same AdVance implant procedure. They were seen 6 weeks later, and examined again at 3, 6, 12, and 24 months. Incontinence was measured using 1-hour and 24-hour pad tests, the number of protective pads used, ICIQ-SF and IQoL questionnaires. Success was defined as no urinary leakage and no pad use. Patient improvement was defined as a reduction of more than 50% in leakage and no more than one pad used per day. Any perioperative and late complications were documented. ResultsFrom January 2007 to November 2012, 113 patients were successfully operated on. At 24 months after surgery, the mean weight of the 1-hour pad test had decreased from 48.7 g to 6.6 g (P < 0.001) while that of the 24-hour pad test decreased to 45.0 g from 113.9 g (P < 0.001). Success and improvement occurred in 22.6% and 58.0% of the patients, respectively. Seventy-five patients (80.6%) used none or one protective pad daily, and the IQoL and ICIQ-SF scores were both significantly improved. Fourteen patients (12.4%) required a second intervention. Three patients (2.7%) had a Clavien IIIb complication. ConclusionThe AdVance Male Sling System is an effective treatment for mild to moderate male stress urinary incontinence. Complications from its use are rare and 24-month results are satisfactory.

337 Assessing the impact of male pelvic mesh surgery on male sexual function: Clinical evaluation of erectile, ejaculation and orgasm functions in men who underwent AdVance male sling surgery

337 Assessing the impact of male pelvic mesh surgery on male sexual function: Clinical evaluation of erectile, ejaculation and orgasm functions in men who underwent AdVance male sling surgery

A cost-utility analysis of artificial urinary sphincter versus AdVance male sling in post prostatectomy stress urinary incontinence: A publicly funded health care perspective.

To investigate the long-term cost-utility of the artificial urinary sphincter (AUS) compared with Transobturator Retroluminal Sling (AdVance) in the treatment of patients with severe post prostatectomy stress urinary incontinence (PPSUI) from a Canadian provincial health perspective. A Markov model with Monte Carlo simulation was developed with a cycle length of 1 year and time horizon up to 10 years to estimate the incremental cost per quality-adjusted life years (QALYs). Patients were assigned to treatment with either AUS or an AdVance sling. Transition probabilities, efficacy data, and utility indices were derived from published literature and expert opinion. Cost data were obtained from provincial health care system and hospital data in 2016-Canadian dollars. The primary outcome was cost per quality-adjusted life year. A standard discount rate of 1.5% was applied annually. Probabilistic and one way deterministic sensitivity analyses were performed. AUS implantation had a 10-year mean total cost of $14 228 (SD ± 3,509) for 7.58 QALYs. AdVance sling had a mean total cost $18 938 (SD ± 12,435) for 6.43 QALYs. The incremental cost savings of AUS over 10-years was -$ 4710 with an added effectiveness of 1.15 QALYs. At a willingness to pay threshold of $50 000, AUS remained the most cost-effective option. A limitation of our analysis is the lack of direct long-term comparisons between both scenarios along with standard success definition. AUS implantation appears to be more economical treatment strategy for severe PPSUI compared with AdVance sling for a publicly funded health care system over a 5- and 10-year time horizon.

The Advance Male Sling as Primary Intervention for Paediatric Incontinence: Preliminary Findings

The Advance Male Sling as Primary Intervention for Paediatric Incontinence: Preliminary Findings

A Cost-Utility Analysis of Artificial Urinary Sphincter Versus Advance Male Sling In Post Prostatectomy Stress Urinary Incontinence: A Canadian Healthcare Perspective

A Cost-Utility Analysis of Artificial Urinary Sphincter Versus Advance Male Sling In Post Prostatectomy Stress Urinary Incontinence: A Canadian Healthcare Perspective

AdVance male sling

The AdVance sling (American Medical Systems, Minnetonka, MN, United States of America) is a synthetic transobturator sling, which is a safe and effective minimally invasive treatment for mild to moderate stress urinary incontinence (SUI) in male patients. This article provides a step-by-step description of our technique for placement of the AdVance male sling, including details and nuances gained from surgical experience, advice for avoidance of complications and discussion on management of complications and sling failures. Patient selection is very important, including exclusion and preoperative treatment of urethral stenosis and bladder dysfunction. Previous pelvic radiation is a poor prognostic factor. In brief, the steps of sling placement are: (I) mobilization of the corpus spongiosum (CS); (II) marking and mobilization of the central tendon; (III) passage of the helical trocar needles exiting at the apex of the angle between the CS and inferior pubic ramus; (IV) fixation of the broad part of the sling body to the CS at the previous mark; (V) cystoscopy during sling tensioning; (VI) placement of a Foley urethral catheter; (VII) Subcutaneous tunnelling of the sling arms back toward the midline; (VIII) wound closure. The most common early postoperative complication is urinary retention but long-term retention is extremely rare. Management of sling failures include placement of an artificial urinary sphincter, repeat AdVance sling, urethral bulking agent or ProACT device.

MP87-04 NATIONAL TRENDS IN UTILIZATION OF SURGICAL THERAPIES FOR POST-PROSTATECTOMY STRESS URINARY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2016MP87-04 NATIONAL TRENDS IN UTILIZATION OF SURGICAL THERAPIES FOR POST-PROSTATECTOMY STRESS URINARY INCONTINENCE Yahir Santiago-Lastra, J. Quentin Clemens, and Bahaa S. Malaeb Yahir Santiago-LastraYahir Santiago-Lastra More articles by this author , J. Quentin ClemensJ. Quentin Clemens More articles by this author , and Bahaa S. MalaebBahaa S. Malaeb More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2354AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The adoption of male perineal sling (MPS) procedures has been thought to increase steadily. Our aim was to evaluate the impact of MPS on utilization of the artificial urinary sphincter (AUS) using data from the vendor as well as regional varations. We hypothesize that despite increasing utilization of the MPS, AUS utilization has continued to steadily increase. METHODS We used sales and revenue unit data provided by American Medical Systems (Boston Scientific, Natick, MA) to retrospectively review the number of AUS (AMS 800) and MPS (AdVance Male Sling System, InVance Male Sling System) that were implanted in males with post-prostatectomy incontinence (PPI) nationwide for the years of 2001 to 2013. Sales results for the MPS were reported as growth rates in utilization, by using this formula: {(Present utilization value) minus (Initial year utilization value) / (Initial year utilization value)}. These are represented as percent growth rates by year. Regional standardized MPS utilization rate (per 100 000 persons) were measured using state/region population and urologist density data as obtained from the most recent AUA census. We excluded devices implanted for revision cases. RESULTS We identified 46,939 original AUS units implanted with patient identification forms (PIFs) reported from 2000-2013. A regression model for the effect of different age groups on the rate of utilization demonstrated that increasing age was associated with an increased rate of utilization of the AUS, with robust yearly increase in utilization for both the 60-69 age group and the 70+ age group, with a stable rate of utilization for men under age 59 (Adjusted R square=0.985, p<0.001). For the MPS, there was a peak in utilization in year 2009 that correlates significantly with utilization rates for the AdVance sling. Since 2009, the growth rate in MPS utilization has decreased significantly. Urologist density correlates with MPS utilization rates by state (p<0.002). No significant decline in overall AUS utilization was observed with the introduction of different male sling products. CONCLUSIONS AUS utilization in the treatment of PPI continues to increase despite introduction of various MPS devices, particularly for older men. Areas with a greater urologist density are associated with greater MPS utilization. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1115-e1116 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yahir Santiago-Lastra More articles by this author J. Quentin Clemens More articles by this author Bahaa S. Malaeb More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation of Salvage Male Transobturator Sling Placement Following Recurrent Stress Urinary Incontinence After Failed Transobturator Sling

To evaluate the outcome of patients treated with a salvage AdVance male sling after a failed primary transobturator sling placement. Retrospective review of patients treated at our center with a primary and subsequent salvage AdVance sling. Success was defined as a dry safety pad or no pads (cured), or >50% improvement in pads used per day and patient satisfaction (improved). Early primary sling failures (<6 months) were compared with late (≥6 months) failures with regard to continence outcomes. We identified 18 patients who underwent a salvage AdVance sling placement at our institution. Overall success was 72% at 6 months postoperatively and 56% at a mean follow-up of 17.5 months, including 50% and 39% of patients who were dry at those same time periods. Patients failing late after their primary sling (n = 8) enjoyed improved outcomes with salvage sling placement compared with patients who failed early (n = 10) after the primary sling. At 6 months, more patients in the late primary failure group were cured (75% vs. 30%; P = .031). These improved cure rates remained significant through final follow-up with cure rates of 63% and 20%, respectively (P = .041). Salvage AdVance male sling is a viable treatment option after a failed primary sling procedure, especially in patients who demonstrated a prolonged efficacy period before primary sling failure.

A pragmatic approach to the characterization and effective treatment of male patients with postprostatectomy incontinence.

To highlight the recent developments in the past 12 months in the field of postprostatectomy incontinence. The evaluation of postprostatectomy incontinence is mainly based on clinical details and symptoms assessment. The situation in which urodynamics will change the management and influence clinical decision-making is still unknown. MRI may play a role in the future for postprostatectomy incontinence assessment. Artificial urinary sphincter is the most widely used treatment, and the literature is full of technical reports to improve the management of challenging cases and minimize the risk of complications. Advance male sling has been the subject of multiple reports that support its safety and efficacy. Many other innovative devices have been presented but not adequately tested. Evaluation of postprostatectomy incontinence is based on clinical data, involving symptoms assessment, quality of life, and incontinence severity. Endoscopy is requested, and urodynamic study indications are debated. The treatment is mainly focused on surgical options, of which artificial urinary sphincter and transobturator male slings are the two leaders. The field is critically lacking of comparative studies.

Comparison of Clinical Outcomes Between “Ideal” and “Nonideal” Transobturator Male Sling Patients for Treatment of Postprostatectomy Incontinence

To review the clinical outcomes of "ideal" vs "nonideal" postprostatectomy stress urinary incontinence (PPI) patients who underwent male sling placement. The medical records of 95 consecutive patients with PPI who underwent male sling insertion (AdVance male sling, American Medical Systems, Minnetonka, MN) were reviewed. Patients were divided into "ideal" vs "nonideal" cohorts. The ideal group consisted of patients with mild to moderate incontinence (<4 pads/day or <300 g daily pad weight), ability to volitionally contract the external urinary sphincter, no history of pelvic radiation or cryotherapy, no history of previous anti-incontinence surgical procedures, the ability to generate a volitional detrusor contraction when voiding, and a postvoid residual urine volume <100 mL. Patients in the nonideal group did not satisfy all these criteria. Significant reductions in daily pad usage and weight were noted in both cohorts. In the ideal patient group, 66 of 72 patients (92%) would undergo the procedure again. Conversely, only 7 of 23 nonideal men (30%) would undergo the procedure again. Preoperative patient selection can influence favorable outcomes after the treatment of PPI with AdVance male slings. Attention to ideal vs nonideal patient characteristics should be used when counseling men considering male sling surgery.

AdVance and AdVance XP slings for the treatment of post-prostatectomy incontinence

To examine the outcomes with the AdVance XP and AdVance slings in the management of post-prostatectomy incontinence (PPI). Eighty patients were treated with the AdVance resp. AdVance XP at one tertiary reference centre. The initial patients were implanted with the AdVance male sling with no associated surgery. Following the introduction of the AdVance XP sling, subsequent patients were implanted with the AdVance XP slings. Measurements included: daily pad usage, 24-h pad weight test, International Quality of Life Questionnaire, International Consultation on Incontinence Questionnaire Short Form and the Patient Global Impression of Improvement. Adverse events were recorded. Follow-up was available for 39 and 41 patients treated with the AdVance and AdVance XP slings, respectively. At a median follow-up of 24.7 months, 69.3 % of patients could be classified as cured or improved in the AdVance group and at a median follow-up of 11.9 months, 90.3 % of AdVance XP-treated patients. At 3-month follow-up, 96.8 and 97.3 % of patients could be classed as cured or improved in the AdVance and AdVance XP groups, respectively (not significant). There were no perioperative complications. Two AdVance and three AdVance XP serious post-operative complications were reported, which were resolved following treatment. QOL was improved in both treatment groups. Both the AdVance and the AdVance XP slings are effective and safe for the treatment of PPI.

Extended Outcomes in the Treatment of Male Stress Urinary Incontinence With a Transobturator Sling

To review extended patient outcomes after male transobturator sling placement for stress urinary incontinence. A retrospective review of a prospectively maintained database for patients with at least 12 months of postoperative follow-up after AdVance male sling placement was performed. Success was defined as a dry safety pad or less (cured) or >50% improvement in pads used per day and patient satisfaction (improved). Patients requiring repeat continence procedures were considered failures. We reviewed data from 102 patients with a minimum of 12 months of follow-up (mean ± standard deviation 36.2 ± 16.5 months). The mean age at surgery was 66.1 years, and 86.4% had previously undergone a prostatectomy. At 12 months, 24 months, and final follow-up, success rates were 74%, 63%, and 62%, respectively. Although cure rates also declined over time, 40% of patients experienced a durable cure with no complaints of wet pads at final follow-up. Complications were minimal and similar with previous reports. Multivariate Cox regression analysis revealed detrusor overactivity and an elevated detrusor pressure and peak flow negatively predicted being cured using sling placement. AdVance sling placement continues to represent a viable option in the treatment of male stress incontinence. Although a decrease in efficacy over time was observed, a substantial portion of patients can expect a durable cure.

The advance transobturator male sling for post-prostatectomy incontinence: Subjective and objective outcomes with 3 years follow up

To determine patient-perceived and clinical outcomes of the AdVance sling at 3 years follow-up in men with post-prostatectomy incontinence (PPI). Data was prospectively collected of men with PPI treated with the AdVance male sling between February 2008 and March 2010. Twenty-four-hour pad counts and weights and patient completed validated questionnaires were obtained pre-operatively and at 3 years. The primary outcome was improvement in pad count with secondary outcomes of questionnaire scores and patient perception of success. At a median follow-up of 39 months (IQR: 36-44), we identified 30 men meeting inclusion criteria who had the AdVance male sling placed for mild to severe PPI. Eighteen (60%) patients were cured (no pad usage or one pad for security) and an additional 4 (13%) showed improvement (≥50% reduction in pad usage). Eight (27%) patients failed: six patients underwent seven salvage procedures including urethral bulking with collagen (n = 1), Virtue perineal sling (n = 1), and artificial urinary sphincter (n = 5). There were 16 post-operative complications: 13 Clavien I, 2 Clavien II, and 1 Clavien IIIb. AdVance male sling is an effective treatment option for PPI evidenced by objective improvements in 24-hr pad count and pad weight and patient perceived success via validated questionnaires.

1374 THE ADVANCE® TRANSOBTURATOR MALE SLING FOR POST-PROSTATECTOMY INCONTINENCE: OBJECTIVE AND SUBJECTIVE OUTCOMES WITH 3 YEARS FOLLOW-UP

Aims: To determine patient-perceived and clinical outcomes of the AdVance sling at 3 years follow-up in men with postprostatectomy incontinence (PPI).Methods: Datawas prospectively collected ofmenwithPPI treatedwith theAdVance male sling between February 2008 and March 2010. Twenty-four-hour pad counts and weights and patient completed validated questionnaires were obtained pre-operatively and at 3 years. The primary outcome was improvement in pad countwith secondary outcomes of questionnaire scores and patient perception of success.Results: At amedian follow-up of 39 months (IQR: 36–44), we identified 30 men meeting inclusion criteria who had the AdVance male sling placed for mild to severe PPI. Eighteen (60%) patients were cured (no pad usage or one pad for security) and an additional 4 (13%) showed improvement ( 50% reduction in pad usage). Eight (27%) patients failed: six patients underwent seven salvage procedures including urethral bulking with collagen (n1⁄4 1), Virtue perineal sling (n1⁄4 1), and artificial urinary sphincter (n1⁄4 5). There were 16 post-operative complications: 13 Clavien I, 2 Clavien II, and 1 Clavien IIIb. Conclusions: AdVance male sling is an effective treatment option for PPI evidenced by objective improvements in 24-hr pad count and pad weight and patient perceived success via validated questionnaires. Neurourol. Urodynam. 34:251–254, 2015. # 2013 Wiley Periodicals, Inc.