title: AdVance/AdVance XP transobturator male slings: preoperative degree of incontinence as predictor of surgical outcome.
abstract: OBJECTIVE
  To evaluate the efficacy of the AdVance transobturator male sling in the treatment of male stress urinary incontinence and to identify the preoperative predictors of a successful outcome.
  
  
  METHODS
  All patients were considered for sling placement 1 year after radical prostatectomy or transurethral resection of the prostate. The degree of incontinence was assessed using the 24-hour pad weight test. A preoperative urodynamic assessment and cystoscopy were performed in all cases. Patients without sphincter contractions during the "repositioning test" were excluded. Since September 2010, we have implanted the AdVance XP transobturator sling. Cure was defined as no pad use.
  
  
  RESULTS
  From February 2008 to June 2011, 61 patients underwent transobturator sling (34 AdVance and 27 AdVance XP) insertion. In 26 cases, the sling was anchored with bioabsorbable sutures, and in 35 cases, it was not fixed. Of the 61 patients, 7 had a history of anastomotic stricture and 3 of radiotherapy. Preoperatively, median 24-hour pad weight was 200 g (range 25-1848). Finally, 26 patients had detrusor overactivity or low bladder compliance. The median follow-up was 26 months (range 12-53). The overall cure rate was 80% (49 of 61). Deterioration of continence was observed during follow-up in 2 patients. The preoperative variables (age, body mass index, 24-hour pad weight, International Consultation on Incontinence Questionnaire-Short Form, adverse urodynamics, sling fixation, AdVance XP) and their association with the surgical outcome were analyzed. The preoperative 24-hour pad weight correlated inversely with the outcome (odds ratio 0.996), with a 0.4% decrease in cure rate for each 1-g increase in the preoperative 24-hour pad weight. The complications included perineal hematoma in 2, acute urinary retention in 9, perineal numbness in 5, and de novo storage symptoms (urgency) in 5 patients.
  
  
  CONCLUSIONS
  The results of our study have shown that the AdVance and AdVance XP male slings are safe and efficient in patients with mild postprostatectomy stress incontinence. The severity of incontinence was the only predictor of a successful outcome.
authors: Department of Urology, Fundación Instituto Valenciano de Oncología, Valencia, Spain. argimirocollado@usa.net
authors: Argimiro
authors: A
authors: Collado Serra
authors: Luís
authors: L
authors: Resel Folkersma
authors: José L
authors: JL
authors: Domínguez-Escrig
authors: Alvaro
authors: A
authors: Gómez-Ferrer
authors: José
authors: J
authors: Rubio-Briones
authors: Eduardo
authors: E
authors: Solsona Narbón
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011468:Prostatectomy / Q000009:adverse effects*; D011474:Prosthesis Design; D011788:Quality of Life; D012189:Retrospective Studies; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D014563:Urodynamics