Five-Year Results of a Prospective Multicenter Trial: AdVance XP for Postprostatectomy-Incontinence in Patients with Favorable Prognostic Factors

Abstract

<b><i>Objective:</i></b> The aim of this study was to assess the security, value, and efficacy of the second-generation AdVance male sling XP (Boston Scientific®), after implementation in 2010 with advantageous modifications in the sling structure and needle shape, in a prospective multicenter long-term follow-up study. <b><i>Methods:</i></b> In total, 115 patients were included. Exclusion criteria were earlier incontinence (UI) surgery, nocturnal UI, former radiotherapy, or night-time incontinence. We also excluded patients with a functional urethra <1 cm in a preoperatively performed repositioning test. A consistent 24-h pad test, International Quality of Life (IQOL) score, visual analog pain scale (VAS), International Consultation-Incontinence Questionnaire (ICIQ-UI SF), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), and Patient Global Impression of Improvement (PGI-I) scores were requested postoperatively. <b><i>Results:</i></b> The 24-month follow-up (114 patients) revealed 64.0% cured and 28.8% improved patients. Mean urine loss was reduced significantly to 19.0 g (<i>p</i> < 0.001). A mean PGI score of 1.5 and a mean VAS score of 0.2 were obtained. The 60-month follow-up (59 patients) revealed 57.6% cured and 25.4% improved patients. Mean urine loss was reduced significantly to 18.3 g (<i>p</i> < 0.001). A mean PGI score of 1.6 and a mean VAS score of 0.2 were obtained. <b><i>Conclusions:</i></b> The AdVance XP displays excellent continence results and secure effectiveness over a 5-year period. Moreover, these data are demonstrating low complication rates and improved quality of life in the long-term use of AdVance XP.

Age at surgery is not a prognostic factor for the AdVance‐XP male sling efficacy: A post‐hoc analysis of a prospective 7‐year multicentric study

“…The 5‐year follow‐up data showed time consistent results with 64.3% of patients cured at 3 months, which only decreased to 57.6% at 60 months. Furthermore, the mean quality of life score (assessed through the IQOL) increased from a 67.3 IQOL score before surgery to 97.0 at 24 months and 96.8 at 60 months 8 . Thus, demonstrating long‐term stable results for PPI patients.…”

“…6 The 5-year follow-up data showed a decrease of dry patients from 64.0% at 2 years, 61.2% after 4 years, and 57.6% after 5 years. 8 This is less than the original Ad-Vance system but still statistically significant. 6 It must be noted though that the lesser decrease in dry AdVance XP system patients could also be a result of a better understanding of the sling system, which ultimately leads to a better patient selection for surgery.…”

“…13 Thus, selection criteria for optimal long-term results should primarily factor in good visual sphincter contractibility and a coaptive zone of at least 1 cm in the preoperative endoscopic evaluation. 8,[13][14][15][16] The strict application of the Bauer et al refined selection criteria showed excellent time-consistent continence results in AdVance XP treated patients at the 5-year follow-up. Furthermore, the 5-year follow-up showed low complication rates and an improved quality of life.…”

“…The strict application of the Bauer et al refined selection criteria showed excellent time‐consistent continence results in AdVance XP treated patients at the 5‐year follow‐up. Furthermore, the 5‐year follow‐up showed low complication rates and an improved quality of life 8 . The refined selection criteria likely contributed to the results.…”

ATOMS (Adjustable Transobturator Male System) Is an Effective and Safe Second-Line Treatment Option for Recurrent Urinary Incontinence after Implantation of an AdVance/AdVance XP Fixed Male Sling? A Multicenter Cohort Analysis

“…If properly applied and correctly indicated, its retrourethral placement leads to dorsal stabilization of bulbar urethra and bulging and repositioning of the membranous urethra with consecutive improvement of functional length [ 2 ]. Cure rates for fMS range between 8.3% and 87%, depending on the definition of the success parameter “cured” and the severity of preexisting incontinence [ 3 , 4 ]. The MASTER trial comparing AUS and fMS based the assessment of treatment success on patient-reported outcome measures (PROMs) in addition to objective criteria and found that 72.2% of patients in the fMS arm were completely or fairly satisfied after a follow-up of 1 year [ 5 ].…”