The AdVance Sling and Male Sexual Function: A Prospective Analysis on the Impact of Pelvic Mesh on Erectile and Orgasmic Domains in Sexually Active Men With Postprostatectomy Stress Urinary Incontinence

Abstract

Background Transvaginal pelvic mesh surgery has been shown to cause female sexual dysfunction. Aim To evaluate the sexual function impact of AdVance male sling (MS) on erectile and orgasmic domains. Methods A review of a prospectively collected database was conducted in all sexually active men who underwent AdVance MS for postprostatectomy stress urinary incontinence between 2012 and 2018. Outcomes Patient demographics, clinical outcomes, and validated questionnaires such as the Brief Male Sexual Function Inventory (BMSFI), International Index of Erectile Function (IIEF) and Patient Global Impression of Improvement (PGI-I) were reviewed at 6, 12 and 24 months. Results Of the total of 65 men who received AdVance sling, an increase in IIEF-5 score ≥5 points were reported in 10 (15%) patients with no patients complained of deteriorating erectile function at 24 months. The improvement in orgasmic function (Question 10 on IIEF-15) was reported in 22 (34%) patients while 3 (5%) patients reported lower orgasmic scores. The sexual domains scores in BMSFI were higher in 40 (62%) patients, especially with regards to sexual desire (Question 1 and 2) and satisfaction with sex life (Question 11). No patient reports pelvic or urethral pain. The reported improvement in erectile and orgasm scores remained similar throughout the 24-months follow-up period. All 20 patients with preoperative climacturia reported resolution of their symptoms during sexual activity. The overall PGI-I was 1.4 (1–3) and men with a higher continence rate were more likely to report better male sexual function (P = .044). Clinical implications AdVance MS appears to improve erectile and orgasmic domains, and there is a positive correlation between urinary continence and male sexual function. Strengths and limitations Strengths of this study include the prospective large patient population analyzed regarding the impact of MS on male sexual function with the use of validated instruments for erectile, orgasmic, and urinary domains. Limitations include single-centre data, relatively short-term follow-up study and lack of a comparative arm. Conclusion Despite the reported adverse effect of sexual dysfunction following pelvic mesh in the female population, the AdVance PMS appears to improve male sexual function with regards to erectile and orgasm domains.

Contemporary male slings for stress urinary incontinence: advances in device technology and refinements in surgical techniques

“…22,[29][30][31][32][33][34][35] More recently, one study reported that the AdVance male sling appears to improve male sexual function with regards to erectile and orgasm domains in addition to urinary continence. 36 Reported adverse events are generally mild with transient urinary retention and groyne pain being the most frequently encountered, and the need for explantation is exceedingly low. 37 Patients with severe incontinence (>400 g/24-h pad weight), a history of prior radiotherapy or coexisting storage dysfunction are more likely to have poorer outcomes.…”

“… 22 , 29 – 35 More recently, one study reported that the AdVance male sling appears to improve male sexual function with regards to erectile and orgasm domains in addition to urinary continence. 36 …”

The therapeutic effect of pelvic floor muscle training on stress urinary incontinence following prostatectomy: a systematic review and meta-analysis

“…Despite excellent disease-specific survival, RP often causes debilitating consequences to continence and erectile function. Urinary incontinence is common after RP, occurring in 2% to 87% of patients ( 4 , 5 ). While continence improves in most men over time, this recovery time is variable with some patients requiring up to 12 months ( 6 , 7 ).…”