You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2016MP87-16 PERINEAL FIXATION IS INFERIOR TO PURELY TRANSOBTURATOR PLACEMENT OF MALE SLING: MULTICENTER STUDY OF SURGICAL ESCALATION. Ryan Terlecki, Kurt McCammon, Jack Zuckerman, Brian Flynn, Joshua Broghammer, Gopal Badlani, and Marc Colaco Ryan TerleckiRyan Terlecki More articles by this author , Kurt McCammonKurt McCammon More articles by this author , Jack ZuckermanJack Zuckerman More articles by this author , Brian FlynnBrian Flynn More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , and Marc ColacoMarc Colaco More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2366AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The male urethral sling is an attractive option for select cases of stress urinary incontinence (SUI). At present, two commercially available male slings are marketed in the United States, AdVanceTM (American Medical Systems, Minnetonka MN) and Virtue® (Coloplast, Minneapolis MN). AdVanceTM is a purely transobturator sling, while Virtue® involves transobturator and prepubic mesh tunneling. Proposed technical modification of Virtue® placement, however, includes suture fixation to the periosteum of the pubic rami, theoretically mimicking the earlier InVance® sling, but without bone anchors. Numerous definitions exist for success and failure after SUI surgery, but it is generally accepted that surgical escalation to an artificial urinary sphincter (AUS) following sling surgery constitutes sling failure. We sought to compare outcomes of perineal fixation versus transobturator elevation by analyzing rates of surgical escalation after AdVanceTM versus InVance®. METHODS A retrospective cohort analysis was performed to compare outcomes of AdVanceTM and InVance® procedures. AdVanceTM data was drawn from the prospectively collected experience of four academic centers with high volume implanters. All cases of AdVanceTM sling placement were included for this analysis, excluding only those with incomplete data. For the InVance® cohort, data was queried from the AMS Patient Information Form (PIF) database. All cases of AdVanceTM and InVance® sling placement were cross-referenced with the PIF database to determine cases of subsequent AUS placement. Overall rates and time to escalation were determined, with a rate comparison performed via chi square analysis. RESULTS 345 patients undergoing AdVanceTM (mean age 67.5 yrs) and 5417 receiving InVance® (mean age 68.3 yrs) were included. Mean follow-up for cases not requiring escalation was 5.6 yrs and 11.2 yrs, respectively. The rate of surgical escalation to AUS was significantly higher for InVance® than AdVanceTM (17.1% vs 11.3%, p = 0.005), with a mean time to escalation of 3.0 yrs and 1.7 yrs, respectively. CONCLUSIONS Based on this multi-institutional study, and in view of historical data, surgical escalation to AUS is significantly less common with a purely transobturator sling than with perineal fixation. This data may have relevance to training on surgical technique and product selection. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1120-e1121 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ryan Terlecki More articles by this author Kurt McCammon More articles by this author Jack Zuckerman More articles by this author Brian Flynn More articles by this author Joshua Broghammer More articles by this author Gopal Badlani More articles by this author Marc Colaco More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...