Sunday June 30, 2019 from 07:30 to 09:00
AdVance/AdVance XP transobturator male slings: Single-centre experience for treatment of post-prostatectomy incontinence
Cameron Lam1, Timothy O. Davies1.
1Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
Introduction: Male stress urinary incontinence (SUI) is a common occurrence after radical prostatectomy. Although the insertion of an artificial urinary sphincter has been the standard of care, over the last 10 years, the transobturator male urethral sling has emerged as a minimally invasive option for management of SUI.
Methods: A retrospective review between June 2010 and June 2018 identified 76 patients who underwent insertion of a transobturator male urethral sling at Hamilton Health Sciences by a single surgeon. Exclusion criteria included patients who had previous surgical management of SUI, neurological disorders affecting voiding, and patients who displayed predominant urge incontinence on urodynamic studies (UDS). All patients were assessed with UDS preoperatively. Incontinence was assessed by number of pad usage per day (PPD) prior to sling procedure, at 1–3 months postoperatively, and at the last documented followup. Severity of SUI was defined as mild (1–2 PPD), moderate (3–5 PPD), and severe (≥6 PPD). Outcomes were defined as cured (≤1 PPD), improved (≥50% PPD reduction), and failed (<50% PPD reduction). A Cox proportional hazard regression model was used to identify possible prognostic variables for failure defined a priori, including age, prior radiation, sling type, body mass index (BMI), time from original procedure to sling insertion, and PPD.
Results: Between June 2010 and June 2018, a total of 23 AdVance and 53 AdVance XP slings were implanted.Average age of the patients was 67.8±6.0 years with a BMI of 28.7±3.6. Median (range) followup time was 8.6 (1.3–81.1) and 13.7 (1.3– 42.9) months for the AdVance and AdVance XP, respectively. Cure rate was 95.7% and 92.5% at last followup for the patients implanted with the AdVance and AdVance XP sling. Univariate analysis showed no difference between the AdVance and AdVance XP in treatment failure rate and the only significant variable predictive of failure was age (hazard ratio [HR] 1.511; p=0.028); multivariate analysis significance toward age (HR 1.211; p=0.041) and a trend toward preoperative pad useage (HR 2.742; p=0.057) as a predictor of failure to cure.
Conclusions: The AdVance and AdVance XP are both effective and safe treatment options for male post-prostatectomy mild to severe SUI and there appears to be no superiority of one over the other. Cure rates were similar at 95.7% and 92.4% for the AdVance and AdVance XP sling at our centre, slightly higher than reported in the literature. Increasing age was a significant prognostic factor in predicting patients who would go on to both ‘failed’ and ‘improved’ outcomes, but likely represents a relationship with overall health and mobility rather than age alone. Preoperative pad usage also showed a trend towards predicting patients who may not go on to complete cure. Prior radiation, BMI, or preoperative urgency were not predictive of failure.