title: Therapeutic durability of the male transobturator sling: midterm patient reported outcomes.
abstract: OBJECTIVE
  The male transobturator AdVance™ sling is a viable option for mild to moderate post-prostatectomy incontinence. As this treatment is relatively new, our study provides an analysis of efficacy through patient reported outcomes and pad use.
  
  
  METHODS
  A telephone survey and chart review were conducted on all patients receiving a sling before 2010 by either of 2 surgeons at a large academic institution. The survey included the Patient Global Impression of Improvement and Severity instruments, pad use characteristics before and after sling surgery, and items assessing durability of efficacy. Patient determined (subjective) success was very much or much better on the Patient Global Impression of Improvement without subsequent incontinence therapy. Quantitative success was defined as a decrease to 2 or fewer pads per day. We assessed therapeutic durability in a subanalysis of patients interviewed twice, first in a prior study.
  
  
  RESULTS
  From initial office followup to 2 years, quantitative success decreased from 87.3% to 62.5% and pad use doubled from a mean±SD of 0.8±1.7 to 1.7±2.5 pads per day. Patient determined success was 53.6% at 2 years. A subgroup of 25 patients interviewed at 7 and 29 months after sling surgery had quantitative success significantly decrease by 20% (p=0.03), subjective success decrease by 4% (p=0.56) and pad use significantly increase (p=0.01) from 1.4±2.2 to 2.3±3.2 pads per day.
  
  
  CONCLUSIONS
  Most patients receiving the AdVance sling did see improvement in post-prostatectomy incontinence and a decrease in pad use, but in 20% of patients this benefit decreased with time. Nevertheless, patients remained satisfied and perceived the treatment as successful.
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio 44195, USA.
authors.forename: Hanhan
authors.initials: H
authors.lastname: Li
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Gill
authors.forename: Amy S
authors.initials: AS
authors.lastname: Nowacki
authors.forename: Drogo K
authors.initials: DK
authors.lastname: Montague
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Angermeier
authors.forename: Hadley M
authors.initials: HM
authors.lastname: Wood
authors.forename: Sandip P
authors.initials: SP
authors.lastname: Vasavada
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects; D053825:Suburethral Slings; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*