title: Treatment of postprostatectomy male urinary incontinence with the transobturator retroluminal repositioning sling suspension: 3-year follow-up.
abstract: BACKGROUND
  The AdVance male sling (American Medical Systems, Minnetonka, MN, USA) has been shown to be an efficacious device in short-term studies for postprostatectomy incontinence (PPI), but long-term studies are lacking.
  
  
  OBJECTIVE
  Examine the intermediate-term outcome with the AdVance sling for PPI management.
  
  
  METHODS
  A multicentre prospective evaluation was conducted on consecutive patients treated for PPI in three European tertiary reference centres.
  
  
  METHODS
  Patients were implanted with the AdVance male sling with no associated surgery.
  
  
  METHODS
  Measurements included daily pad usage, maximum flow rate (Qmax), postvoid residual urine (PVR), the International Consultation on Incontinence Questionnaire-Short Form, the Incontinence Quality of Life questionnaires, and complications of surgery. Paired Wilcoxon signed rank test univariable and multivariable analyses were used.
  
  
  CONCLUSIONS
  Follow-up was available for 156 patients for the majority of parameters. Pad usage was significantly decreased compared with baseline at 12 mo and 3 yr (p<0.0001). At 12 mo, 76.9% of patients could be classified as cured or improved; this percentage was maintained at 3 yr (76.8%). Cure rates (58.6% vs 42.3%) and improvement rates (23.2% vs 25.0%) were higher in patients with mild or moderate incontinence compared with severe incontinence. Univariable analysis showed that pretreatment pad usage and severity of incontinence were both significant predictors of success (p=0.0355 and p=0.0420, respectively). However, in multivariable analysis, only pad usage was an independent predictor of success. There were no perioperative or severe postoperative complications. Most complications were Dindo grade I. Seven patients required a second treatment for stress urinary incontinence. There was no worsening over time. Limitations of this study included no comparator group, quality of life questionnaires in only two centres, and no 24-h pad test.
  
  
  CONCLUSIONS
  The transobturator retroluminal repositioning sling suspension is effective and safe in the longer term for treating PPI.
authors.affiliation: Department of Urology, Medical University, Innsbruck, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Rehder
authors.forename: Francois
authors.initials: F
authors.lastname: Haab
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Cornu
authors.forename: Christian
authors.initials: C
authors.lastname: Gozzi
authors.forename: Ricarda M
authors.initials: RM
authors.lastname: Bauer
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D016496:Incontinence Pads / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology* / Q000523:psychology / Q000628:therapy*