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Abstract: A number of anatomic components work in concert to produce precise control of micturition in the healthy male, including the sphincter with its striated and smooth muscle components, the surrounding muscular and ligamentous support structures, neural components, and the urothelium. Radical prostatectomy is often associated with injury to one or more of these tissues, culminating in stress urinary incontinence (SUI). Although the causes of urinary incontinence can vary, among patients with residual urethral sphincter function, the increased laxity and reduced functional length of the membranous urethra are thought to play key roles in incontinence. Most surgical treatments for urinary incontinence, such as the artificial urinary sphincter and various slings, achieve continence via compression of the urethra, but the AdVance® transobturator retrourethral sling (American Medical Systems, Minnetonka, MN, USA) repositions the urethral sphincter complex back into the pelvis and increases the functional membranous urethral length. Emerging reports on the AdVance® sling suggest favourable cure rates and few complications. Thus, the AdVance® sling provides an alternative approach to treating postprostatectomy SUI that is both less obstructive and more dynamic. [Copyright &y& Elsevier]

Abstract: The AdVance® male sling (American Medical Systems, Minnetonka, MN, USA) is a retrourethral transobturator sling that offers an effective surgical approach for the treatment of postprostatectomy stress urinary incontinence (SUI). Clinical studies have demonstrated success rates of 80–90% at 1-yr follow-up. The most appropriate candidate patients for the AdVance® sling may be those with mild to moderate incontinence, but success rates may not be markedly lower in patients with severe incontinence. Clinical experience with the AdVance® sling suggests that cystoscopically confirmed residual sphincter function is an important requirement for good outcome. Assessment of SUI should be modified to include a consideration of sphincter function in addition to the currently accepted definitions of incontinence severity (pad weight and number). The AdVance® male sling may be considered a first-line surgical treatment as well as a salvage treatment for some patients who have failed previous surgical treatment. More data are needed to better understand the patient-related factors that affect the short- and long-term outcomes of this minimally invasive treatment for male SUI. [Copyright &y& Elsevier]