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Title: AdVance male urethral sling: medium-term results in an Australian cohort.
Epworth Authors: Moon, Daniel
Other Authors: Papachristos, Alexander
Mann, Sarah
Talbot, Kay
Keywords: AdVance Male Urethral Sling
Stress Urinary Incontinence
Quality of Life
Functional Outcomes
International Consultation on Incontinence Questionnaire
Patient Global Impression of Improvement
Robotic Surgery, Epworth Healthcare, Australia
UroRenal, Vascular Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Feb-2017
Publisher: WIley
Citation: ANZ J Surg. 2017 Feb 27.
Abstract: BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
DOI: 10.1111/ans.13890
PubMed URL:
ISSN: 1445-2197
Journal Title: ANZ Journal of Surgery
Type: Journal Article
Affiliated Organisations: Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Urology, Cabrini Hospital, Melbourne, Victoria, Australia.
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Type of Clinical Study or Trial: Cohort Study
Appears in Collections:UroRenal, Vascular

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