Transcript Clinical Efficacy and Patient Satisfaction of the New

Clinical Efficacy and Patient
Satisfaction of the New
AdVanceTM (Non BoneAnchored) Male Sling
Tarek Pacha1, Darryl R.Reaume2, Jon
Suleskey2, Jeff Schock2
Henry Ford Macomb Hospital – Warren Campus1,
Introduction
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Devastating!!
25-33%
Management up to 1 year is conservative
AUS Gold standard
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Morbid
Technically challenging
Pt with mild incontinence
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<5 pads
Better understanding of mid-urethral
sling in women
Development of Male sling
Bone anchored
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Can have serious complications
Non bone-anchored sling (2006)
Methods
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Prospective study
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Efficacy
patient satisfaction/expectation
UCLA PCI (urinary function section) questionnaire
14 patients by single surgeon
Pre-Op: hx<5 pads, cysto, urodynamics
Prostatectomy most common cause
Methods
• Position: Dorsal lithotomy and place foley
• Perineal incision
• Dissect to bulbospongiosus muscle and split in the
midline
• Perform urethral dissection
• Pass the transobturator needle pass bilaterally
• Place sling and tension appropriately
• Close perineal wound
• Post-op: no heavy lifting for 4-6 wks
Mechanism of Action
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restore proper anatomical position to
augment or assist external sphincter
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Proximal and cephalad displacement (3.5cm)
Important: Pre-op sphincter function
Circumferential coaptation
Final Position
Results
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7 out of 11 patients (78.6%) who used 3 or more
pads before surgery used 0-2 pads after surgery
(p<.0082).
Nine patients (64.3%) improved to either 1-2 pads or
0 pads.
7 out of 14 (50%) reported an improvement in bother.
Over 50% of the patients were at least moderately
satisfied and that the procedure met their
expectations.
No infections or erosions to date
One patient with prolonged UR that required
urethrolysis
Conclusions
• AdVanceTM male sling
• encouraging option for mild-moderate UI
• Low morbidity
• How to optimize success rates?
• good patient selection
• appropriate pre-op work up.
• Limitation
• Longer follow-up vs AUS
Thank you!
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[1] Herr H. Quality of life in incontinent men undergoing radical
prostatectomy. J Urol 1994;151:652-654
[2] Atul Rajpurkar, Rahmi Onur, Ajay Singla. Patient Satisfaction and Clinical
Efficacy of the New Perineal Bone-Anchored Male Sling. European Urology
47(2005) 237-242
[3] UCLA Prostate Cancer Index
[4] Urology Times: Using urethral slings to manage post-RP incontinence,
5/2008.
[5] Nathan Ullrich, Craig Comiter. The Male Sling for Stress Urinary
Incontinence: 24-Month Followup with Questionnaire Based Assessment
[6] Peter Rehder and Christian Gozzi. Transobturator Sling Suspension for
Male Urinary Incontinence Including Post-Radical Prostatectomy. European
Urology 2007: 52: issue 3; 860-867.