Efficacy of the InVance™ Male Sling in Treating Stress Urinary Incontinence: A Three-Year Experience from a Single Centre

Abstract

Introduction: The aim of this study was to evaluate the efficacy of the InVance™ male sling in treating stress urinary incontinence. Patients and Methods: We retrospectively reviewed operative logs from a single surgeon of 43 patients treated over a 3-year period (Feb. 2004 to Nov. 2006) for stress incontinence by implantation of a male bulbourethral bone-anchoring sling (InVance™). The mean follow-up time was 24.2 months (range 4–38). Radical prostatectomy was the most common cause of incontinence in this group (33/ 43 cases; 76.7%). Efficacy was evaluated objectively in terms of the number of pads used per day, while subjective patient satisfaction was also recorded. We also investigated a possible correlation between preoperative parameters and outcome. Results: Twenty-two patients (51.2%) were cured (totally dry: 30.2%; the remainder: 1 pad per day), while 8 (18.6%) patients improved but still required two pads per day. Overall, 30 of 43 patients (69.6%) were satisfied with the outcome of the operation. Postoperative infection was the most common complication (11.6%). The severity of preoperative incontinence correlated with the outcome of the operation, with mild incontinence giving better results. Conclusions: The bone-anchored male sling is an effective and minimally invasive treatment for mild-to-moderate male urinary incontinence.

The male sling for post‐prostatectomy urinary incontinence: a review of contemporary sling designs and outcomes

“…Organic sling materials have been shown to degrade [16–18], and therefore synthetic mesh is now the primary material for BAS (InVance sling; American Medical Systems [AMS], Minnetonka, Minnesota, NC, USA). The degree of sling tension is an important part of this procedure, and many different methods have been reported: retrograde perfusion pressure of 30–50 cmH 2 O [18,19] or >60 cmH 2 O [20–22], cough test [16,17,22] or maximal compression with or without a urethral catheter in place [23–27]. The compressive effect of a BAS on the urethra has been shown with dynamic MRI [24].…”

“…It has been hypothesized that the BAS improves continence by causing a degree of urethral obstruction, and allowing better transmission of intra‐abdominal pressure to the bulbar urethra [24]. In all, 12 unique case series were identified that reported the results of bone anchored slings (Table 1) [14,16–18,20–32].…”

“…Most case series reporting on the BAS used only patient‐reported daily pad use as the outcome, with either ≤1 ppd [20,21,25], or dry/improved [14,17,23,27] as the primary outcome. Success rates are relatively consistent in these studies at 40–88% (Fig.…”

“…[17] did not show that the aetiology of UI was a risk factor for failure, but their sample size is underpowered for such analysis. Multiple series have found that the degree of preoperative SUI is a significant risk factor for failure of the BAS [17,20,22,23,25,27].…”

“…Some superficial infections were successfully treated with antibiotics. In men with postoperative mesh infections, 75% (18/24) required surgical explantation of the sling [18,20,21,23–25,27,34]. Most infections occurred early, but late infections at 3 months and 1 year have been reported [24,34].…”