Continence outcomes with the AdVance ® sling

1. Results Median follow up was 6 months (mean 11, range 1-63 months). Patient age ranged from 56-86yr. (mean 68). The median time of AdVance® sling insertion post RP was 36 months with the earliest at 12 months. 40 (95%) of patients had formal urodynamics and cystoscopy as part of the workup. The overall success rate at 6months follow up was 78.5%, with 71% being dry immediately post op. 15 of 20 (75%) of those experiencing mild PUI were continent immediately post op, Of those, 1 had previous Macroplastique and 1 had a previous failed sling. 2 more (10%) becoming continent at 6 month and the other 10% are still not continent and requiring medication. 15 of 20 (75%) of those experiencing moderate PUI were also continent immediately post op, 1 patient had failed attempts previously at Macroplastique and a bone anchored sling (Invance). A further 1 patient had previous Macroplastique. One patient became continent by three months, however 4 (20%) remain incontinent with 2 of those requiring AUS. One of those patients who had AUS required another AUS operation 16months after the initial AUS failed. Both patients (100%) with severe SUI remained incontinent and went on to have AUS before continence was achieved. 4 (9%) had prior exposure to EBRT - Two patients with mild incontinence, where one was immediately dry after the procedure and the other remains incontinent even with the addition of medication. One patient with moderate incontinence and one with severe incontinence had prior EBRT, they were not continent after AdVance sling implantation and subsequently went on to have an AUS inserted. 3 separate patients were exposed to EBRT after Advance sling was inserted and all three remain continent at follow up. The complication rate of 26% included one patient with perineal pain greater than expected for the surgery, 2 had acute urinary retention which settled spontaneously and 2 patients had late leaks. 9 of 42 (21%) patients required further treatment to attain continence . Introduction Despite increased anatomical understanding and variety of treatment modalities available for the treatment of carcinoma of the prostate, a proportion of patients who undergo radical retropubic prostatectomy (RP) with or without adjuvant radiation therapy continue to experience post procedural urinary incontinence (PUI). The AdVance® sling is a minimally invasive retro-urethral sling implant designed for the treatment of male stress urinary incontinence (SUI). Conclusions The AdVance® sling is an effective method for regaining continence in the post prostatectomy patient with mild to moderate stress urinary incontinence. It has limited effect in patients with severe incontinence or who have undergone adjuvant external beam radiotherapy prior to insertion. Results obtained in this series are en keeping with previously reported series (2,3). Methods A retrospective review of patients undergoing AdVance® slings inserted by a single surgeon between September 2007 and August 2011 in the West Morton Health District in South East Queensland was undertaken. 42 patients with post procedure Stress Urinary Incontinence (SUI) were included in the study. 41 (98%) cases were precipitated by radical prostatectomy and one case was due to transurethral resection of the prostate (TURP). Sling implantation was perfomed by a single AdVance® sling trained consultant urologist at a single centre. The surgical technique was according to AdVance® sling protocols and has been described previously (1). Preoperative workup included urine analysis, flexible cystoscopy (to identify presence/mobility of sphincter, rule out stricture) and urodynamic assessment (to exclude storage dysfunction). Inclusion criteria were patients that had proven stress urinary incontinence at the earliest 12 months after radical prostatectomy or TURP, including patients with mild to severe incontinence and patients who had previous procedures (Not AUS) to gain continence and failed. Severity of incontinence was classified as mild (1-2 pads/day or <100ml pad weight), moderate (2-4 pads/day or 100-500ml pad weight) or severe (>4 pads /day or >500ml pad weight). Patient follow up was with the surgeon at routine outpatients 2-4 week after the operation and then 3 monthly and/or as per follow up for radical prostatectomy. Once continence was achieved and prostatectomy management complete, the patient was followed up by their general practitioner unless a new referral for further incontinence was made. Cure rate was defined as dry with no pad useat first or subsequent follow up visits within 6months of procedure. Follow up included patients who did not achieve continence and who required further medical or surgical procedures (Macroplastique, AUS) Acknowledgements DrHS Teng, Department of Urology, Ipswich Hospital, Ipswich, Queensland Aim Between Sept 2007 and August 2011, 42 AdVance® slings were inserted by a single surgeon in the West Moreton Health District, South East Queensland for post procedural incontinence. Presented is his experience with this device. References Rapp DE, Reynolds WS, Lucioni A, Bales GT. Surgical technique using AdVance sling placement in the treatment of post-prostatectomy urinary incontinence. International braz j urol : official journal of the Brazilian Society of Urology. 2007;33(2):231-5; discussion 6-7. 2. Bauer RM, Mayer ME, Gratzke C, Soljanik I, Buchner A, Bastian PJ, et al. Prospective Evaluation of the Functional Sling Suspension for Male Postprostatectomy Stress Urinary Incontinence: Results after 1 Year. European urology. 2009;56(6):928-33. 3. Cornu J-N, Sebe P, Ciofu C, Peyrat L, Beley S, Tligui M, et al. The AdVanceTransobturator Male Sling for Postprostatectomy Incontinence: Clinical Results of a Prospective Evaluation after a Minimum Follow-up of 6 Months. European urology. 2009;56(6):923-7. No. 054 Continence outcomes with the AdVance® sling G. EVANS1, R. FOWLER1, HS. TENG1,2 1Ipswich Hospital, Ipswich, Queensland; 2St. Andrew’s Hospital, Ipswich, Queensland Poster presentation sponsor