Functional follow‑up after Advance ® and Advance XP ® male sling surgery: assessment of predictive factors

Abstract

Purpose: To evaluate the efficacy of the Advance® and AdvanceXP® slings in men with stress urinary incontinence (SUI) post-radical prostatectomy and to identify predictive factors for outcome. Methods: Included were male patients with SUI following radical prostatectomy who had a positive “repositioning test”, 24 h-pad weight (PW) test < 400 g and who were continent at night and at rest. Urgency was defined as a sudden compelling desire to pass urine, which was difficult to defer. The cure rate was defined as no pad use. Results: From February 2008 to October 2014, 24 AdVance® and 70 AdVance XP® were implanted. The median (range) follow-up was 49 (12–102) months. The overall cure rate was 77%. The preoperative 24 h PW was significantly related to the continence outcome (p = 0.044). A total of 12 patients (13%) presented with postoperative AUR, which was significantly related to abnormal voiding detrusor activity (p = 0.036). Twenty-two patients (23%) had postoperative urgency (16% “de novo”), which was significantly related to preoperative urgency (p = 0.003). During follow-up, a degree of deterioration of continence was observed in five patients who were classed as cured initially. To date, no reports of urethral sling erosion have been made. Conclusions: The AdVance® and AdVanceXP® slings are safe and effective in relieving SUI following post-radical prostatectomy. There were no differences between the two slings in terms of efficacy, urgency or postoperative AUR. There was a moderate rate of “de novo “urgency and low rate of loss of continence during follow-up.