title: Mid-term outcomes of a male retro-urethral, transobturator synthetic sling for treatment of post-prostatectomy incontinence: Impact of radiotherapy and storage dysfunction.
abstract: To determine mid-term durability of the AdVance sling for post-prostatectomy incontinence (PPI) and impact of prior radiotherapy and storage dysfunction.
  
  
  
  Eighty men undergoing AdVance sling for PPI during 2008-2013 were reviewed. Pre-op urodynamics, pre and post-op pad usage, prior radiotherapy, and PGI-I scores were recorded.
  
  
  
  Mean follow-up was 36 months (range 14-72). Twelve men had radiotherapy pre-op, 10 had detrusor overactivity (DO), and 20 reduced compliance. Pre-op mean 24-hr pad weight was 264 g and mean pads-per-day (PPD) 2.60 ± 0.29. In the early post-op period (3-6 months), mean PPD was 0.40 (SD 0.16); at mid-term follow-up mean PPD was 1.02 ± 0.31. Radiotherapy and DO were independently predictive of poor mid-term outcome. Men with DO or radiotherapy were using 1.03 ± 0.42 (P = 0.019) and 1.17 ± 0.41 (P = 0.02) more PPD, respectively than men without these factors. At mid-term follow-up, men without radiotherapy or DO were using 1.98 ± 0.28 less PPD compared to pre-operatively (P < 0.0001); with radiotherapy or DO men were using 0.73 ± 0.38 (P = 0.057) and 0.72 ± 0.43 (P = 0.092) less PPD, respectively. PGI-I score for men without radiotherapy or DO was 1.98 ± 0.40 ("much better"); with radiotherapy or DO PGI-I score was 3.80 ± 0.49 ("no difference").
  
  
  
  The AdVance sling provides mid-term improvement in men with PPI. However, men with radiotherapy or DO have significantly poorer outcomes with mid-term results indicating a return to baseline degree of incontinence. Caution should be taken when considering the AdVance sling in these men. Pre-op urodynamics in men with radiotherapy and/or overactive bladder may be important when considering men for AdVance sling. Neurourol. Urodynam. 36:1147-1150, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Concord Repatriation General Hospital, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Habashy
authors.affiliation: Concord Repatriation General Hospital, Sydney, Australia.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Losco
authors.affiliation: Department of Urology, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Tse
authors.affiliation: Concord Repatriation General Hospital, Sydney, Australia.
authors.forename: Ruth
authors.initials: R
authors.lastname: Collins
authors.affiliation: Department of Urology, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia.
authors.forename: Lewis
authors.initials: L
authors.lastname: Chan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D016496:Incontinence Pads; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D019919:Prosthesis Implantation; D011878:Radiotherapy / Q000009:adverse effects*; D053825:Suburethral Slings; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000150:complications* / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics
keywords: AdVance sling; detrusor overactivity; incontinence; prostatectomy; radiotherapy; urodynamics