Mid‐term outcomes after AdVanceXP male sling implantation

Abstract

ObjectiveTo describe efficacy and safety of the AdVanceXP (Boston Scientific, Marlborough, MA, USA) retrourethral transobturator male sling after a mean follow‐up of almost 3 years.Patients and MethodsA total of 41 patients underwent AdVanceXP implantation between July 2010 and March 2012 by a single surgeon. Patients were prospectively evaluated at baseline, after a mean follow‐up of 12months and after an individual maximum follow‐up. Efficacy was evaluated by daily pad usage, 24‐h pad testing, and validated questionnaires (International Consultation on Incontinence questionnaire [ICIQ]). Patient satisfaction was determined using the Patient's Global Impression of Improvement score; quality of life was evaluated using the International Quality of Life (IQOL) score. Patients needing 0 or 1 safety pad with a daily urine loss <8 g were classified as cured. To assess the changes in outcome over time, a Wilcoxon signed‐rank test was used. A P value <0.05 was taken to indicate statistical significance.ResultsThe mean ± sd follow‐up was 33.1 ± 8.1 months. A total of four patients (9.8%) were lost to follow‐up. At follow‐up, 56.1% of patients used 0 or 1 dry safety pad, 17.1% used 1 pad, and 17.1% used 2 pads. Mean pad use was 0.6 pads per day (P < 0.001 vs baseline) with a mean urine loss of 14 g per day. After nearly 3 years, 46.3% of the patients could be classified as cured and 29.3% could be classified as improved. When comparing respective outcomes after 1 and 3 years, no significant changes in mean daily pad use (0.8 at 1 year; P = 1.000), in ICIQ score (5.0 at 3 years vs 5.2 at 1 year; P = 0.500), or in IQOL score (89.2 at 3 years vs 86.8 at 1 year; P = 0.500) were observed. Patients lost less urine based on 24‐h pad testing after nearly 3 years (14 g at 3 years vs 28 g at 1 year; P = 0.106). Subgroup analyses showed no significant differences in efficacy in patients who had previously received radiotherapy or in patients with mild preoperative incontinence. Between 1 and 3 years postoperatively, no complications were detected.ConclusionsThe present study had the longest follow‐up for AdVanceXP to date and is the first to show a high efficacy even after a mean follow‐up of almost 3 years. The results indicate that late‐onset complications are rare after AdVanceXP implantation.

Long-term Outcome of the Retrourethral Transobturator Male Sling After Transurethral Resection of the Prostate

“…However, none of the aforementioned studies focused on post-TURP SUI. Regarding PPI, the longest follow-up after AdVanceXP implantation is 2 years in a prospective multicenter study, and nearly 3 years in a recent prospective single-center study [8,20]. Thus, the current study provides the longest follow-up after retrourethral transobturator male sling implantation to date.…”

“…Additionally, the questionnaire included detailed instructions for a 24-hour pad test and enough pads for more than 24 hours. These instructions are well established at the institution and have been used in multiple previous studies [19,20]. Daily pad usage was assessed.…”

Long‐term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study

“…The present study is the first long‐term follow‐up analysis of the ATOMS device with the largest patient series (287 patients) to date. With a median observation period of 31 months of all consecutive implantations (maximum follow‐up 75 months) the present study has a similar design to other retrospective studies of popular male slings such as Argus classic (101 patients, mean follow‐up 24 months) , ArgusT (42 patients, mean 29 follow‐up months) , Advance (156 patients, follow‐up up to 36 months) , AdvanceXP (41 patients, mean follow‐up 31 months) , and ProAct balloons (22 patients, median follow‐up 57 months) .…”

The role of male slings in post prostatectomy incontinence: ICI‐RS 2015

“…A small retrospective study suggested dry and improved rates were better with the new AdVance XP system (90.3% vs 69.3%) although mean follow up was longer with the AdVance sling compared to AdVance XP (24.7 vs 11.9 months) . In a recently published study, with nearly 3 years mean follow up, cure rates (no or security pad and <8 g loss in 24 h pad test) and improved rates with AdVance XP MS were 46% and 76%, respectively . Interestingly radiation did not lead to adverse outcomes ( n = 7) which the authors put down to a thorough pre‐operative work up and an adequate coaptation zone on testing.…”

“…19 In a recently published study, with nearly 3 years mean follow up, cure rates (no or security pad and <8 g loss in 24 h pad test) and improved rates with AdVance XP MS were 46% and 76%, respectively. 20 Interestingly radiation did not lead to adverse outcomes (n = 7) which the authors put down to a thorough pre-operative work up and an adequate coaptation zone on testing. Three patients needed transection of one of the sling arms as a result of de novo overactive bladder symptoms and/or persistent urinary retention.…”