Surgical technique using AdVance™ Sling placement in the treatment of post-prostatectomy urinary incontinence

Abstract

Objectives: To describe and illustrate a new minimally invasive approach to the treatment of male stress urinary incontinence following prostatectomy. Surgical Technique: Our initial experience consisted of four patients treated with the Advance sling for post-prostatectomy urinary incontinence. Sling placement involves the following steps: 1. Urethral dissection and mobilization, 2. Identification of surgical landmarks, 3. Placement of needle passers through the obturator foramen, 4. Mesh advancement, 5. Mesh tensioning and fixation, 6. Incision closure. Comments: Based on our initial experience, we believe that the Advance Male Sling System may be a safe technique for the treatment of male stress urinary incontinence. This technique is easy to perform and may offer a reproducible, transobturator approach. Further patient accrual is ongoing to assess the safety and reproducibility of this technique. Also, additional study will focus on efficacy standards and complication rates.

Biomaterials in the treatment of pelvic organ prolapse and stress urinary incontinence: An update

“…The membranous urethral length increased from a mean of 3 mm (range, 0-7 mm) to 17.2 mm (range, 10-22 mm) after tape placement. The mean urethral closure pressure improved from 13.2 cm (range, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] cm H 2 O to 86.5 (range, 70-100) cm H 2 O. Pre-and postoperative maximum fl ow rates did not differ signifi cantly. Complications included perineal discomfort and tape migration.…”

“…Advantages of the male sling include physiologic voiding, less invasive procedure, lower costs, and immediate results [ 17 ]. The bulbourethral sling can be placed by several techniques, including via bone anchors to the inferior pubic ramus [ 17 ], retropubically [ 16 ], or via the obturator foramen [ 18 ]. The most recent development is the transobturator approach.…”

“…When the sling is tensioned, a circumferential partial occlusion is created. The technique has been described with the following steps: urethral dissection and mobilization, identifi cation of the surgical landmarks, placement of needle passers through the obturator foramen, mesh advancement, mesh tensioning and fi xation (self anchoring in the obturator muscles and fascia), and closure of the incision [ 18 ]. In a study of 20 patients, Rehder and Gozzi [ 20 ] reported on the transobturator approach for male urinary incontinence.…”

Periurethral constrictor: late results of the treatment of post prostatectomy urinary incontinence

“…One study showed that when there is need for cuff change, AS 800´s erosion rates are much higher and the surgeries are technically more difficult, ranging from 43% to 50% (28). Currently, fixed compression and adjustable devices are indicated for patients with mild to moderate incontinence (26,29). For patients with severe incontinence the standard treatment seems to be the AS 800 (27,30).…”

Sphincter urinaire artificiel, bandelettes sous-urétrales et ballonnets. Choix de la stratégie thérapeutique chez l’homme non neurologique

“…Ainsi, de nombreuses études en rapportent les résultats, dont celle de Madjar [36] rapporte le suivi de leur cohorte avec 48 patients sur 24-60 mois (suivi moyen de 48 mois), avec toujours 65 % de patients secs et 15 % améliorés avec une protection par jour. D'autres bandelettes ou d'autres voies d'implantation ont également été décrites sans proposer d'amélioration des résultats par rapport aux bandelettes avec ancrage osseux, comme la voie transobturatrice avec des études incluant peu de patients ou les bandelettes ajustables avec au moins deux retensions de la BSU et 64,7 % de patients secs [37,38]. Enfin, la taille des études, d'une part, et la définition des critères de guéri-son variables d'une étude à l'autre, d'autre part, doivent faire moduler les résultats.…”