Introduction

1. No. 100 A leak point pressure of greater than 100cm H2O predicts success of AdVanceTM sling placement for the treatment of post-prostatectomy incontinence. Andre Westenberg FRACS, Jon Barnard MBChB, Simon van Rij, MBChB, Liam Wilson FRACS Bay Urology, Tauranga, New Zealand. Posters Proudly Supported by: Introduction The AdVance male sling is indicated for the treatment of “mild to moderate” post-prostatectomy incontinence in men. In practice “mild or moderate” incontinence is commonly assessed by the number of pads used per 24hr; a subjective measure which does not take into account the fastidiousness or the different activity levels of patients. The valsalva leak point pressure is an objective measure of urinary incontinence which we hypothesise can be utilised to predict success of the sling procedure. Results 47 men with a mean age of 67 years (54-83) underwent AdVancesling surgery. 10 men had undergone HoLEP, 1 a TURP, and 36 had undergone radical prostatectomy (RP). 11 men had a leak-point-pressure (LPP) of ≤ 100 cm H2O. Of these 11 men, there were 3 failures (27%), with all 3 requiring a secondary procedure (AUS) to regain continence. In contrast 33 of the 36 men with a LPP >100cm H2O had a successful outcome (92%). Of the 3 failures, one was successfully salvaged with a repeat sling, another with an AUS and the third with ProACT balloons. There was no difference seen in success rates between those that had undergone HoLEP and those that had undergone RP. Successful surgery was more likely in those with a leak point pressure greater then 100cm H2O compared to those with less then 100cm H2O. (Odds ratio of 4.2 , 0.69 – 24, 95%CI). The value of using a LPP of 100cm H2O as a cut off was recognised early in the series and this study suffers from the fact that the failure rate was relatively small (hence the wide confidence intervals). Data continues to be collected and we hope to be able to narrow the confidence intervals with the recruitment of more patients. Aim To determine the leak point pressure (LPP) at which the AdVance sling is likely to be successful for the treatment of post-prostatectomy stress urinary incontinence. Methods Preoperative urodynamic and post operative outcomes data was prospectively gathered on all patients undergoing AdVance sling placement over 5 year period. Video-urodynamics were employed with the LPP defined as the lowest pressure at which leakage into the urethra was observed with either cough or valsalva. The outcome of sling implantation was compared with the preoperative leak point pressure. The sling was defined as having been successful if the patient no longer had to wear pads or merely used a pad to provide a sense of security. Conclusion A leak point pressure of greater than 100cm H2O reliably predicts success of AdVance sling placement in men with post-prostatectomy urinary incontinence. Video-urodynamics is an objective, available, and relatively simple pre-operative study that is helpful in patient selection for this procedure.