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Clinical Efficacy and Patient Satisfaction of the New AdVance TM (Non Bone-Anchored) Male Sling

Clinical Efficacy and Patient Satisfaction of the New AdVance TM (Non Bone-Anchored) Male Sling. Tarek Pacha 1 , Darryl R.Reaume 2 , Jon Suleskey 2 , Jeff Schock 2 Henry Ford Macomb Hospital – Warren Campus 1 ,. Introduction. Devastating!! 25-33% Management up to 1 year is conservative

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Clinical Efficacy and Patient Satisfaction of the New AdVance TM (Non Bone-Anchored) Male Sling

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  1. Clinical Efficacy and Patient Satisfaction of the New AdVanceTM (Non Bone-Anchored) Male Sling Tarek Pacha1, Darryl R.Reaume2, Jon Suleskey2, Jeff Schock2 Henry Ford Macomb Hospital – Warren Campus1,

  2. Introduction • Devastating!! • 25-33% • Management up to 1 year is conservative • AUS Gold standard • Morbid • Technically challenging

  3. Pt with mild incontinence • <5 pads • Better understanding of mid-urethral sling in women • Development of Male sling • Bone anchored • Can have serious complications • Non bone-anchored sling (2006)

  4. Methods • Prospective study • Efficacy • patient satisfaction/expectation • UCLA PCI (urinary function section) questionnaire • 14 patients by single surgeon • Pre-Op: hx<5 pads, cysto, urodynamics • Prostatectomy most common cause

  5. Methods • Position: Dorsal lithotomy and place foley • Perineal incision • Dissect to bulbospongiosus muscle and split in the midline • Perform urethral dissection • Pass the transobturator needle pass bilaterally • Place sling and tension appropriately • Close perineal wound • Post-op: no heavy lifting for 4-6 wks

  6. Mechanism of Action • restore proper anatomical position to augment or assist external sphincter • Proximal and cephalad displacement (3.5cm) • Important: Pre-op sphincter function • Circumferential coaptation

  7. Final Position

  8. Results • 7 out of 11 patients (78.6%) who used 3 or more pads before surgery used 0-2 pads after surgery (p<.0082). • Nine patients (64.3%) improved to either 1-2 pads or 0 pads. • 7 out of 14 (50%) reported an improvement in bother. • Over 50% of the patients were at least moderately satisfied and that the procedure met their expectations. • No infections or erosions to date • One patient with prolonged UR that required urethrolysis

  9. Conclusions • AdVanceTM male sling • encouraging option for mild-moderate UI • Low morbidity • How to optimize success rates? • good patient selection • appropriate pre-op work up. • Limitation • Longer follow-up vs AUS

  10. Thank you! • [1] Herr H. Quality of life in incontinent men undergoing radical prostatectomy. J Urol 1994;151:652-654 • [2] Atul Rajpurkar, Rahmi Onur, Ajay Singla. Patient Satisfaction and Clinical Efficacy of the New Perineal Bone-Anchored Male Sling. European Urology 47(2005) 237-242 • [3] UCLA Prostate Cancer Index • [4] Urology Times: Using urethral slings to manage post-RP incontinence, 5/2008. • [5] Nathan Ullrich, Craig Comiter. The Male Sling for Stress Urinary Incontinence: 24-Month Followup with Questionnaire Based Assessment • [6] Peter Rehder and Christian Gozzi. Transobturator Sling Suspension for Male Urinary Incontinence Including Post-Radical Prostatectomy. European Urology 2007: 52: issue 3; 860-867.

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