Treatment of postprostatectomy incontinence with the AdVance® sling suspension: Our initial experience
G. Štimac, I. Grubišić, Š. Šoipi, I. Svaguša, D. Trnski,
Clinical Department of Urology, “Sestre milosrdnice” University Hospital Center, Zagreb,
BACKGROUND AND OBJECTIVES: Stress urinary incontinence continues to present a major complication following radical prostatectomy. Suburethral slings represent one of the less invasive options for postprostatectomy incontinence (PPI), and a more recent addition is transobturator sling, the AdVance®. We report our short-term results with the AdVance® sling for management of PPI.
MATERIAL AND METHODS: The evaluation was conducted on 30 patients implanted with AdVance® for PPI in our center (November 2010 – April 2014). Measurements included age, etiology of PPI, folow-up and daily pad usage (preoperative and postoperative). Patients were classified as cured based on no pad or one pad for security reasons or as improved if one or two pads were used and if there was a reduction in daily pad usage of 50%.
RESULTS: In our series of 30 patients we observed a reduction of median pad usage of 5.6 (2-8) to 2.3 (0-6) postoperatively. Preoperatively, 0%, 36.7% and 73.3% of the patients were using no pads, 1-4 pads, and >5 pads per day. Postoperatively, 53.3% of the patients were using no pads, 33.3% were using 1-4 pads and only 13.4% were using >5 pads per day, respectively. The postoperative reduction in pad usage of more than 50% was observed in 80% patients. After median follow-up of 24 mo (1–42) the cure rate was 53.4%, and the improvement rate 23.3%. The overall success rate was 76.7% (failure rate: 23.3%). Failure rates for patients with additional treatments after prostatectomy were much higher (60% for radiation therapy and 66.7% for internal urethrotomy group). Two patients had wound infection and one had passing urinary retention after one week of catheter placement.
CONCLUSIONS: Our short-term results suggest favourable cure rates with few complications and are comparable to results from larger series. Our experience suggests that cystoscopically confirmed residual sphincter function is an important requirement for good outcome. The most appropriate candidates for the AdVance® sling may be those with mild to moderate PPI. The results may even be better in patients without additional treatment following radical prostatectomy such as radiation therapy or internal urethrotomy for stricture disease.