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Clinical Efficacy and Patient Satisfaction of the New AdVance TM (Non Bone-Anchored) Male Sling. Tarek Pacha 1 , Darryl R.Reaume 2 , Jon Suleskey 2 , Jeff Schock 2 Henry Ford Macomb Hospital – Warren Campus 1 ,. Introduction. Devastating!! 25-33% Management up to 1 year is conservative

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clinical efficacy and patient satisfaction of the new advance tm non bone anchored male sling

Clinical Efficacy and Patient Satisfaction of the New AdVanceTM (Non Bone-Anchored) Male Sling

Tarek Pacha1, Darryl R.Reaume2, Jon Suleskey2, Jeff Schock2

Henry Ford Macomb Hospital – Warren Campus1,

introduction
Introduction
  • Devastating!!
  • 25-33%
  • Management up to 1 year is conservative
  • AUS Gold standard
    • Morbid
    • Technically challenging
pt with mild incontinence
Pt with mild incontinence
  • <5 pads
  • Better understanding of mid-urethral sling in women
  • Development of Male sling
  • Bone anchored
    • Can have serious complications
  • Non bone-anchored sling (2006)
methods
Methods
  • Prospective study
    • 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
methods1
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
Mechanism of Action
  • restore proper anatomical position to augment or assist external sphincter
    • Proximal and cephalad displacement (3.5cm)
    • Important: Pre-op sphincter function
  • Circumferential coaptation
results
Results
  • 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
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
Thank you!
  • [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.