AdVance Sling Research Articles

Oral 13 - The Transobturator Sub-urethral Sling: A Safe and Effective Option for all Degrees of Post Prostatectomy Urinary Incontinence

Male stress urinary incontinence (SUI) after radical prostatectomy (RP) is common. The surgical standard of care traditionally has been placement of an artificial urinary sphincter (AUS) but since its introduction the transobturator male sling has been shown to have particular unique advantages. Our aim was to assess outcomes of a consecutive series of suburethral sling insertions in men presenting with all degrees of post RP SUI.A consecutive cohort of men undergoing AdVance sling insertion following RP were studied. Parameters assessed included pre and postoperative urinary function, 24 hour pad use, quality of life (QoL) outcomes, complications and further treatments. Degree of incontinence was categorized as mild (1-2), moderate (3-5) or severe (≥ 6) depending on daily pad use. Patients were reviewed at 1, 4 and 6 months. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess symptom severity and QoL outcomes.Seventy-seven patients were included, mean age 68 and mean time to sling post RP 34 (8-113) months. Preoperative degree of incontinence: mild 22%, moderate 58%, severe 20%. Fourteen percent had undergone post RP radiation therapy (RT). In total 73% experienced complete resolution of symptoms post sling, 12% significant improvement, 15% no reduction in pad use. Sixty percent with severe incontinence were classified as cured (no pad or 1 dry pad for security reasons). When patients with preoperative RT were excluded, cure rate rose to 82%. On follow up survey at 30 months (mean), the ICIQ-SF score decreased from baseline 17.7 (9-21.0) to 8.0 (0-20) (p < 0.0001), CI 95% (8-12).Suburethral slings are effective and safe for all degrees of post RP incontinence, are associated with improved QoL parameters and with appropriate selection and counseling are a viable option for more severe degrees of post RP SUI.

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.

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 post-prostatectomy stress urinary incontinence

ABSTRACT Introduction The transvaginal pelvic mesh surgery has been shown to cause female sexual dysfunction. Given this pelvic mesh concern in women, there is similar concern whether men who received pelvic mesh for postprostatectomy stress incontinence (PPSI) may suffer from sexual dysfunction too. Objective To evaluate the sexual function impact of AdVance pelvic male sling (PMS) on erectile and orgasmic domains. Methods A review of a prospectively collected database was conducted in all sexually active men who underwent AdVance MS for PPSI between 2012 and 2018. Patient demographics, clinical outcomes and validated questionnaires such as the Brief Sexual Function Inventory (BSFI), International Index of Erectile Function (IIEF) and Patient Global Impression of Improvement (PGI-I) were reviewed at 6, 12 and 48 months. Results Of the total of 65 men who received AdVance PMS, 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 score. 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=0.044). Conclusions Despite the reported adverse outcomes of pelvic mesh in female sexual dysfunction, the AdVance PMS appears to improve male sexual function with regards to erectile and orgasm domains. Disclosure Work supported by industry: no.

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

Коррекция недержания мочи после радикальной простатэктомии. Хирургическая техника шаг за шагом

Introduction. The main cause of stress urinary incontinence in men is prostate surgery - radical prostatectomy, transurethral resection of the prostate (TURP), enucleation, etc. The gold standard for the surgical treatment of urinary incontinence after prostate surgery is the implantation of an artificial urinary sphincter. For the treatment of mild/moderate urinary incontinence, implantation of synthetic urethral male slings is recommended. For the treatment of severe urinary incontinence, implantation of artificial urinary sphincter recommended. According to the Decree of the Moscow Government dated 12.24.2019 N 1822-PP, surgical interventions on the organs of the genitourinary system with the implantation of synthetic complex and mesh prostheses are included in the standards for the provision of high-tech medical care. Materials and methods. The paper presents a surgical technique for implantation of an artificial urinary sphincter model AMS 800 (Boston Scientific, Boston, MA, USA) and a male urethral sling AdVance XP (Boston Scientific, Boston, MA, USA). The indications for surgical treatment of stress urinary incontinence in men are listed, the criteria for selecting patients for the implantation of an artificial bladder sphincter and the installation of a urethral sling are described, and described in detail. Conclusion. The materials presented in the lecture will help urologists in mastering the technique of implantation of an artificial bladder sphincter and urethral sling in men.

Urinary retention after AdVance™ Sling: A multi-institutional retrospective study.

To identify risk factors for urinary retention following AdVance™ Sling placement using preoperative urodynamic studies to evaluate bladder contractility. A multi-institutional retrospective review of patients who underwent an AdVance Sling for post-prostatectomy stress urinary incontinence from 2007 to 2019 was performed. Acute urinary retention (AUR) was defined as the complete inability to void or elevated post-void residual (PVR) leading to catheter placement or the initiation of intermittent catheterization at the first void trial postoperatively. Bladder contractility was evaluated based on preoperative urodynamics. Of the 391 patients in this study, 55 (14.1%) experienced AUR, and 6 patients (1.5%) had chronic urinary retention with a median follow-up of 18.1 months. In total, 303 patients (77.5%) underwent preoperative urodynamics, and there was no significant difference between average PdetQmax (26.4 vs. 27.4 cmH2 O), Qmax (16.6 vs. 16.2 ml/s), PVR (19.9 vs. 28.1 ml), bladder contractility index (108 vs. 103) for patients with or without AUR following AdVance Sling. Impaired bladder contractility preoperatively was not predictive of AUR. Time to postoperative urethral catheter removal was predictive of AUR (odds ratio, 0.83; 95% confidence interval, 0.73-0.94; p = .003). Chronic urinary retention after AdVance Sling placement is uncommon and acute retention is generally self-limiting. No demographic or urodynamic factors were predictive of AUR. Patients who developed AUR were more likely to have their void trials within 2 days following AdVance Sling placement versus longer initial catheterization periods, suggesting that a longer duration of postoperative catheterization may reduce the occurrence of AUR.

Artificial Urinary Sphincter Outperforms Sling for Moderate Male Stress Urinary Incontinence

ObjectivesTo determine the role of slings and artificial urinary sphincters (AUS) in the management of mild and moderate stress urinary incontinence (SUI). MethodsA retrospective review of our single-surgeon male SUI database was completed. Men having AUS or AdVance sling procedures between 2008 and 2019 were included in the analysis. Those with severe incontinence and/or incomplete pre- or postoperative data were excluded. All patients were evaluated by standing cough test and stratified according to the Male Stress Incontinence Grading Scale. Scores of 0-1 and 2-3 defined mild and moderate SUI, respectively. We performed 2 analyses: (a) sling outcomes were compared between mild vs moderate SUI patients, and (b) for men with moderate SUI, we compared outcomes between slings and AUS. Treatment failure was defined as >1 pad per day or need for subsequent incontinence procedure. ResultsAmong 202 sling cases, those with mild SUI had significantly higher success rate (69/88, 78%) than those with moderate SUI (72/114, 63%; P = .02). Among the 179 men with moderate SUI, those who underwent AUS had significantly higher success rate (52/65, 80%) than those who underwent sling (72/114, 63%; P = .02). ConclusionMale slings are more effective for men with mild SUI than for men with moderate SUI. Men with moderate SUI have a higher success rate with AUS than with sling.

A pilot study of autologous rectus fascial wrap at the time of artificial urinary sphincter placement in patients at risk of cuff erosion.

Cuff erosion is one of the dreaded complications of artificial urinary sphincter (AUS) implantation. Patients with a history of pelvic irradiation are at increased risk of erosion. To reduce the risk of erosion we describe a novel technique and report theresults in our initial series of patients. A prospective analysis of patients treated with AUS and rectus fascial wrap was performed. Inclusion criteria were severe urinary incontinence (UI) and previous pelvic radiation therapy (RTX). Primary outcomes were erosion rate, complications and continence rate. Secondary outcomes were patient satisfaction. Twenty-three patients were analysed. The median age was 70years. Nine (39%) had previous surgery; 6/9 had an Advance sling, 2/9 had a Virtue sling, and 1/9 had an AUS which had eroded. Median pad use was five pads/day IQR, (4-6). Median pad weight was 630ml, 6cm of fascia was harvested in every case, but cuff size varied. Complications occurred in 6/23 (26%): two patients with Clavien 1 and four patients with Clavien 3B (urinary retention requiring suprapubic catheter). In all cases, the retention resolved. One patient presented at 3months post-op with erosion (4.3% erosion rate). Median follow-up was 32months, IQR (24-37). Excluding the patient with erosion, 17/22 (77.3%) of patients achieved complete continence, while 5/22 (22.7%) achieved social continence. The autologous fascial wrap technique is efficient and easy to harvest, with comparable clinical outcomes to other techniques. The medium-term results have been encouraging, but longer-term follow up is needed.

Strong correlation between standing cough test and 24-hour pad weights in the evaluation of male stress urinary incontinence.

We sought to compare in-office physical exam findings via standing cough test (SCT) versus 24-hour pad weights among men seeking treatment for postprostatectomy stress urinary incontinence (SUI). A retrospective review of a single surgeon database of incontinence procedures was performed. Documentation of SUI severity (grades 0-4) was completed by SCT preoperatively utilizing the Male Stress Incontinence Grading Scale (MSIGS). All patients had pads per day (PPD) and 24-hour pad weights obtained. We determined the Spearman's correlation coefficient between these variables. We identified 104 men who underwent anti-incontinence surgery (AdVance Sling or artificial urinary sphincter [AUS]). In the sling group (65 patients), nearly all (97%) had minimal incontinence with SCT (MSIGS = 0-2). In the AUS group (39 patients), most patients (69%) had an MSIGS 3 or 4 with SCT. Spearman's coefficient between quantification of SCT and pad weight for the overall group was ρ = .68 (P < .0001) demonstrating a strong positive correlation. PPD was also strongly correlated with pad weight (ρ = .55, P < .0001). As seen previously, SCT and PPD were correlated (ρ = .47, P < .0001). In a multivariable model predicting pad weight, the effect of SCT was greater than PPD (β = 83 [54-111], P < .0001 vs 45 [2169], P = .0004). SCT findings strongly correlate to 24-hour pad weights in the evaluation of male SUI. The SCT shows promise as a rapid, reliable, noninvasive measure of SUI severity before anti-incontinence surgery.

PD37-04 ADVANCE XP® FOR THE TREATMENT OF POST-PROSTATECTOMY-INCONTINENCE: 5 YEAR DATA OF A PROSPECTIVE MULTICENTRE STUDY

INTRODUCTION AND OBJECTIVES:In recent years, several studies have shown the effectiveness and safety of the AdVance sling (Boston Scientific, formerly American Medical Systems) for treating male st...

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.

196 Refining Male Sling Selectivity Improves Outcomes: Role of Standing Cough Test in Physical Demonstration of Mild Male Stress Urinary Incontinence

We reviewed our 9-year surgical experience with male AdVance sling cases, determining clinical features associated with treatment success in an effort to refine procedure selectivity. We hypothesized that preoperative physical demonstration of stress urinary incontinence (SUI) by standing cough test (SCT) improves patient selection for male transobturator sling surgery. A retrospective review of men undergoing primary AdVance sling surgery between 2008-2016 was performed. Patients without preoperative SCT were excluded. Treatment success was defined as ≤1 PPD postoperatively and no further intervention. SCT was performed during preoperative consultation and objectively graded using the Male Stress Incontinence Grading Scale (MSIGS). Of the 203 male sling patients with complete data, 80 (39%) failed during a median follow up of 63.5 months. From 2008-2016, the proportion of male transobturator slings performed as a surgical treatment modality for SUI declined from 66% to 13%. Increasing sling selectivity correlated with greater treatment success. Treatment success was greater among men without radiation (64% vs 41%; p=0.02), having a history (≤2 PPD; 77% vs 36%; p<0.0001) and physical findings of mild SUI (MSIGS grade 0-2 incontinence on SCT; 67% vs 26%; p<0.0001). In combination, non-radiated men with mild SUI and favorable SCT had an 81% treatment success rate. Incremental increases in PPD usage (OR 1.8 per pad; p<0.0001) and MSIGS grade (OR 1.7 per grade; p=0.005) were independently associated with treatment failure, while history of radiation trended towards significance (OR 2.2; p=0.09).

Improving Male Sling Selectivity and Outcomes—A Potential Role for Physical Demonstration of Stress Urinary Incontinence Severity?

IntroductionWe reviewed our 9-year experience with AdVance™ Male Sling System cases to determine clinical features associated with treatment success and to refine procedure selectivity. We hypothesized that preoperative physical demonstration of stress urinary incontinence by the standing cough test improves patient selection for male sling surgery. MethodsRetrospective review of primary AdVance sling surgeries between 2008 and 2016 was performed. Patients without standing cough test results were excluded from study. Success was defined as 1 pad per day or less postoperatively and no further intervention. Standing cough test was performed during preoperative consultation and objectively graded using the MSIGS (Male Stress Incontinence Grading Scale). ResultsOf the 203 male patients who underwent sling placement 80 (39%) experienced treatment failure during a median followup of 63.5 months. From 2008 to 2016 the proportion of AdVance slings performed as a surgical treatment modality for stress urinary incontinence decreased from 66% to 13%. Increasing selectivity correlated with greater treatment success. Success was greater among men using 2 pads per day or less preoperatively (77% vs 36%, p <0.0001), having physical findings of mild stress urinary incontinence (MSIGS grade 0-2 on standing cough test, 67% vs 26%, p <0.0001) and without a history of radiation (64% vs 41%, p=0.02). In combination, men without prior radiation with mild stress urinary incontinence and favorable standing cough test were “ideal patients” with an 81% success rate. Incremental increases in pad per day use (OR 1.8 per pad, p <0.0001) and MSIGS grade (OR 1.7 per grade, p=0.005) were independently associated with treatment failure. ConclusionsIncreasing selectivity has improved sling outcomes for men with stress urinary incontinence. Ideal sling candidates have not received radiation therapy, and have history and physical findings suggestive of mild stress urinary incontinence.

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.

MP32-14 A COST-EFFECTIVENESS ANALYSIS OF ARTIFICIAL URINARY SPHINCTER VERSUS ADVANCE MALE SLING IN POST PROSTATECTOMY STRESS URINARY INCONTINENCE: A CANADIAN PERSPECTIVE

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures II1 Apr 2017MP32-14 A COST-EFFECTIVENESS ANALYSIS OF ARTIFICIAL URINARY SPHINCTER VERSUS ADVANCE MALE SLING IN POST PROSTATECTOMY STRESS URINARY INCONTINENCE: A CANADIAN PERSPECTIVE Samer Shamout, Sara Nazha, Alice Dragomir, Noemie Prevost, and Lysanne Campeau Samer ShamoutSamer Shamout More articles by this author , Sara NazhaSara Nazha More articles by this author , Alice DragomirAlice Dragomir More articles by this author , Noemie PrevostNoemie Prevost More articles by this author , and Lysanne CampeauLysanne Campeau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.989AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The artificial urinary sphincter (AUS) remains the ″gold standard″ for the treatment of post prostatectomy stress urinary incontinence (PPSUI). However, in recent years, minimally invasive, less expensive sling device (AdVance) are offered as potential alternative treatments. We sought to investigate the long-term cost-utility of the AUS compared with Transobturator Retroluminal Repositioning Sling (AdVance) in the treatment of severe PPSUI. METHODS A Markov model with Monte-Carlo simulation was developed to estimate the incremental cost-effectiveness ratio (ICER) of AUS vs. AdVance sling from a provincial payer perspective over a 10-year period. Probability estimates, success rates, healthcare resources and utilities were obtained from published literature when available or by expert opinion. Cost data included in this model were obtained from provincial health care insurance system and hospital data in 2016-Canadian Dollars. RESULTS AUS Implantation had a 10-year mean total cost of $12299 (SD±3509) for 8.53 quality-adjusted life years (QALYs). On the other hand, AdVance sling had a mean total cost of $20675 (SD±12435) for 7.98 QALYs. The cost-utility analysis over a 10-year period showed that AUS becomes cost-effective when compared to AdVance sling starting the 4th year in the treatment period. The incremental cost savings of AUS over 10-year period was $8376 with an added effectiveness of 0.55 QALYs. Consequently, the AUS implementation is the dominant strategy over the AdVance sling over a 5- and 10-year time-horizon. CONCLUSIONS Although the initial cost of sling is attractive, superior long-term outcomes are demonstrated with durable high success rate of AUS in men with severe PPSUI. Hence, the AUS implementation strategy over a 10-year period time is estimated to be more economical to our health care system. More studies are needed to define utility values for health states experienced by males with PPSUI. This will enhance our ability to develop more accurate cost-utility models. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e414 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Samer Shamout More articles by this author Sara Nazha More articles by this author Alice Dragomir More articles by this author Noemie Prevost More articles by this author Lysanne Campeau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

AdVance male urethral sling: medium-term results in an Australian cohort.

Since 2008, the AdVance male urethral sling has emerged as a minimally invasive option for stress urinary incontinence. We aimed to evaluate the success of the AdVance sling using validated continence outcome measures. A total of 72 patients treated with the AdVance sling completed validated questionnaires reporting on quality of life and functional outcomes. Incontinence was assessed according to pad weight, pad usage per day (PPD), International Consultation on Incontinence Questionnaire scores and Patient Global Impression of Improvement scores. At a median 52-month follow-up, 37 (51%) patients were pad free or used a security pad; 18 (25%) used ≥50% fewer PPDs; and the remaining 17 (24%) patients were classified as 'failed'. According to pad weights, 27 (38%) patients were dry; 32 (44%) had mild incontinence (<100 mL/day); and 13 (18%) had moderate (100-400 mL/day) or severe (>400 mL/day) incontinence. Patient satisfaction was high, with 57 (79%) very much or much better, six (8%) somewhat better and only nine (13%) unchanged or worse. There was a trend of declining continence over time, although the majority remained improved. Patients with severe preoperative incontinence performed significantly worse postoperatively (P = 0.02), as did those who had had prior pelvic radiotherapy (P = 0.02). The AdVance sling offers a high rate of success for the treatment of mild to moderate post-prostatectomy incontinence according to PPD; however, when using objective measures of continence, the success rates are lower. The improvement in urinary control is largely durable over the medium term; however, they may decline beyond 4 years. Reduced efficacy is seen in those with a history of radiotherapy and severe incontinence, although the majority of these men are still improved with surgery.

36-month data for the AdVance XP® male sling: results of a prospective multicentre study.

To evaluate the efficacy and safety of the AdVance XP® sling (Boston Scientific, formerly American Medical Systems) in male stress urinary incontinence (SUI) after radical prostatectomy in a prospective multicentre study, as in recent years several studies have shown the effectiveness and safety of the AdVance sling for treating male SUI and in 2010 the second-generation AdVance XP was introduced with several changes in the sling design and a new needle shape. In all, 115 patients were included. Patients with nocturnal UI, previous UI surgery, previous radiotherapy and a coaptive zone of <1 cm in the preoperative repositioning test were excluded. Postoperatively, a standardised 24-h pad test, quality-of-life scores [International Quality of Life score (IQOL) and International Consultation on Incontinence Questionnaire short form (ICIQ-UI SF)], visual analogue scale (VAS) for pain, five-item version of the International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS) and Patient Global Impression of Improvement (PGI-I) score, were performed. All patients with a 0-5 g pad test were defined as cured and improved with a reduction of urine loss of >50%. All others were classified as failures. Significance analysis was performed using the Wilcoxon test. The mean (median) preoperative urine loss in the 24-h pad test was 272.0 (272.0) g. After a follow-up of 3 months (114 patients), 64.9% of the patients were cured and 31.6% had an improved continence status. The mean urine loss decreased significantly to 34.9 g (P < 0.001), with a mean VAS score of 0.5, and mean PGI-I of 1.5. After a follow-up of 24 months (80 patients), 68.8% of the patients were cured and 22.5% had improved. The mean urine loss decreased significantly to 19.1 g (P < 0.001), with a mean VAS score of 0.3, and mean PGI-I of 1.5. After a follow-up of 36 months (47 patients), 66.0% of the patients were cured and 23.4% had improved. The mean urine loss decreased significantly to 21.8 g (P < 0.001), with a mean VAS score of 0.0, and mean PGI-I of 1.6. The mean IQOL and ICIQ-UI SF improved significantly (both P < 0.001) after 36 months. There were no significant postoperative changes in IIEF-5 and IPSS. No intraoperative and no long-term complications occurred. No erosion or explanations occurred. The AdVance XP shows good and stable effectiveness and low complication rates even at a mid-term follow-up of up to 36 months.

Mid-term outcomes of a male retro-urethral, transobturator synthetic sling for treatment of post-prostatectomy incontinence: Impact of radiotherapy and storage dysfunction.

To determine mid-term durability of the AdVance sling for post-prostatectomy incontinence (PPI) and impact of prior radiotherapy and storage dysfunction. Eighty men undergoing AdVance sling for PPI during 2008-2013 were reviewed. Pre-op urodynamics, pre and post-op pad usage, prior radiotherapy, and PGI-I scores were recorded. Mean follow-up was 36 months (range 14-72). Twelve men had radiotherapy pre-op, 10 had detrusor overactivity (DO), and 20 reduced compliance. Pre-op mean 24-hr pad weight was 264 g and mean pads-per-day (PPD) 2.60 ± 0.29. In the early post-op period (3-6 months), mean PPD was 0.40 (SD 0.16); at mid-term follow-up mean PPD was 1.02 ± 0.31. Radiotherapy and DO were independently predictive of poor mid-term outcome. Men with DO or radiotherapy were using 1.03 ± 0.42 (P = 0.019) and 1.17 ± 0.41 (P = 0.02) more PPD, respectively than men without these factors. At mid-term follow-up, men without radiotherapy or DO were using 1.98 ± 0.28 less PPD compared to pre-operatively (P < 0.0001); with radiotherapy or DO men were using 0.73 ± 0.38 (P = 0.057) and 0.72 ± 0.43 (P = 0.092) less PPD, respectively. PGI-I score for men without radiotherapy or DO was 1.98 ± 0.40 ("much better"); with radiotherapy or DO PGI-I score was 3.80 ± 0.49 ("no difference"). The AdVance sling provides mid-term improvement in men with PPI. However, men with radiotherapy or DO have significantly poorer outcomes with mid-term results indicating a return to baseline degree of incontinence. Caution should be taken when considering the AdVance sling in these men. Pre-op urodynamics in men with radiotherapy and/or overactive bladder may be important when considering men for AdVance sling. Neurourol. Urodynam. 36:1147-1150, 2017. © 2016 Wiley Periodicals, Inc.

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 ...

Systematic review of surgical treatment of post radical prostatectomy stress urinary incontinence.

Context Stress urinary incontinence (SUI) after radical prostatectomy (RP) continues to be a significant problem with several implications including patient quality of life and other critical postoperative outcomes. Objectives To report the results in terms of efficacy (pad count, 24 hr pad test, QOL questionnaires) and safety (complication rate and type of complications) of all surgical devices approved for the treatment of SUI after RP. Evidence Acquisition A systematic review was conducted in accordance with the PRISMA Statement. A literature search was carried out through the PubMed/Medline, SCOPUS, and Web of Science databases using the keywords "incontinence," "radical prostatectomy," and "'treatment". Inclusion criteria were: number of patients higher than 30, mean follow up longer than 12 months and definition of a successful outcome as the use of 0 to 1 safety pads a day. Evidence Synthesis 113 papers underwent primary review. 51 papers met the inclusion criteria with a total sample size of 4022 patients. Efficacy (0-1 safety pads) was on average 65.7% for AUS, 48.2% for Invance Sling, 48.8% for Advance Sling, 64.2% for ProACT. Twenty four hour pad test and QOL questionnaires were respectively available only in 4 and 18 studies. The overall complication rate was 19.43% for AUS, 7.4% for Invance Sling, 12.3% for Advance Sling, 12.3% for ProACT. Authors' Conclusions Due to the poor overall quality of available studies, it was impossible to identify or refute clinically important differences between the alternative surgical procedures. Although our data seems to suggest that AUS has the highest efficacy in the treatment of SUI following RP it is also associated with the highest complication rate, but this may be due to the longest follow up. Larger rigorous trials are needed in order to support this evidence. Neurourol. Urodynam. 35:875-881, 2016. © 2015 Wiley Periodicals, Inc.