The AdVance™ male sling: does it stand the test of time?

Abstract

Introduction

There is minimal data published on the longevity of the transobturator retrobulbar male sling (AdVance™). We aimed to determine the efficacy, the complication rate and need for salvage SUI surgery in the medium to long term for male sling insertion.

Materials and methods

We performed a retrospective review of all patients undergoing male sling insertion at a single centre between 2009 and 2018. Data on patient demographics, pre and post-operative International Consultation on Continence Questionnaire – Urinary Incontinence (Short Form) (ICIQ-UI(SF)) scores and 24 h pad usage were collected. Success was calculated as a combination of the cured rate (0–1 security pad use) and the improved rate (>50% reduction in pad usage). Data was also collected on complications, patient satisfaction as well as need for further SUI surgery.

Results

A total of 91 patients underwent male sling insertion in the period specified; median follow up was 69 months. Success rates at 3 months in mild SUI, moderate SUI and severe SUI groups were 96, 86 and 80%, respectively. In the medium to long term, this drops to 65, 62 and 47%, respectively. The overall rate of artificial urinary sphincter (AUS) implantation was 15%. Common complications included groin pain (3%), infection (3%), urinary retention (10%) and de novo overactive bladder (OAB) (11%). The only factor predicting success or failure was pre-operative ICIQ-UI(SF) score.

Conclusions

AdVance™ male sling success rates deteriorate from 89% at 3 months to 61% at 5 years. The risk of complications is low and, for the most part, transient. Sling insertion remains a reasonable treatment option for male patients suffering with stress urinary incontinence (SUI).

Keywords:

• Male sling
• post-prostatectomy incontinence
• incontinence

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

IGR, TK and MB conceived the study. IGR and MP collated the results. PR and RS analyzed the data. PR wrote the manuscript. All authors reviewed and amended the manuscript before submission.