Mid-term evaluation of the transobturator male sling for post-prostatectomy incontinence: focus on prognostic factors

Study Type – Therapy (outcomes research) Level of Evidence 2b OBJECTIVE • To assess clinical outcomes at mid-term follow-up and determine preoperative factors associated with the failure of the AdvanceTM male sling for post-prostatectomy incontinence (PPI). PATIENTS AND METHODS • A prospective evaluation was conducted of 136 consecutive patients implanted with the AdvanceTM male sling for mild to moderate stress urinary incontinence after prostatectomy. • Patients were preoperatively evaluated using medical history, ASA score, urodynamics, 24-h pad test and pad usage. • The clinical outcome was evaluated according to pad use and the Patient Global Impression of Improvement scale and by assessment of side effects. ‘Cure’ was defined as no pad usage and ‘improvement’ as a decrease in pad use by >50%. • Factors related to functional outcome were studied by univariate and multivariate analysis. RESULTS • After a mean ± SD (range) follow-up of 21 ± 6 (12–36) months, 62% of patients were cured, 16% improved and 22% not improved. • Failure (no cure or improvement) was associated with previous urethral stricture surgery (P= 0.013) and a 24-h pad-test >200 g/day (P= 0.026), and there was a trend for an association with previous radiation therapy (P= 0.053). • Age, learning curve and type of prostatectomy did not affect the results. • Immediate postoperative complications were limited to two cases of dysuria, one case of perineal haematoma and two cases of perineal paresthesia. During follow-up, 10% of patients had perineal pain and 14% of patients had mild dysuria. None required surgical management. CONCLUSION • The results of the present study, with a follow-up of up to 3 years, confirm that the AdvanceTM male sling is an efficient treatment for PPI. However, particular attention should be given to the preoperative data associated with failure.