title: AdVance male urethral sling: medium-term results in an Australian cohort.
abstract: BACKGROUND
  Since 2008, the AdVance male urethral sling has emerged as a minimally invasive option for stress urinary incontinence. We aimed to evaluate the success of the AdVance sling using validated continence outcome measures.
  
  
  METHODS
  A total of 72 patients treated with the AdVance sling completed validated questionnaires reporting on quality of life and functional outcomes. Incontinence was assessed according to pad weight, pad usage per day (PPD), International Consultation on Incontinence Questionnaire scores and Patient Global Impression of Improvement scores.
  
  
  RESULTS
  At a median 52-month follow-up, 37 (51%) patients were pad free or used a security pad; 18 (25%) used ≥50% fewer PPDs; and the remaining 17 (24%) patients were classified as 'failed'. According to pad weights, 27 (38%) patients were dry; 32 (44%) had mild incontinence (<100 mL/day); and 13 (18%) had moderate (100-400 mL/day) or severe (>400 mL/day) incontinence. Patient satisfaction was high, with 57 (79%) very much or much better, six (8%) somewhat better and only nine (13%) unchanged or worse. There was a trend of declining continence over time, although the majority remained improved. Patients with severe preoperative incontinence performed significantly worse postoperatively (P = 0.02), as did those who had had prior pelvic radiotherapy (P = 0.02).
  
  
  CONCLUSIONS
  The AdVance sling offers a high rate of success for the treatment of mild to moderate post-prostatectomy incontinence according to PPD; however, when using objective measures of continence, the success rates are lower. The improvement in urinary control is largely durable over the medium term; however, they may decline beyond 4 years. Reduced efficacy is seen in those with a history of radiotherapy and severe incontinence, although the majority of these men are still improved with surgery.
authors.affiliation: Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Papachristos
authors.affiliation: Australian Urology Associates, Melbourne, Victoria, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mann
authors.affiliation: Australian Urology Associates, Melbourne, Victoria, Australia.
authors.forename: Kay
authors.initials: K
authors.lastname: Talbot
authors.affiliation: Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Australian Urology Associates, Melbourne, Victoria, Australia.|Department of Urology, Cabrini Hospital, Melbourne, Victoria, Australia.|Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Moon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
keywords: male urethral sling; prostatectomy; urinary stress incontinence