Long-Term Functional Outcomes and Complications of AdVance™/AdVance XP™ Male Suburethral Slings in the Management of Post-Prostatectomy Incontinence: Multicentric Prospective Ten-Year Follow-Up Study.

Abstract

Introduction: Male sling implants are an acceptable treatment for post-prostatectomy stress urinary incontinence, but more long-term follow data is needed to assess clinical effectiveness. This study provides long-term continence and quality of life outcomes using complete 10-year follow up data from patients with AdVance™/AdVance XP™ Male Sling Systems.

Methods: In an observational multicenter study, prospective data collection included preoperative patient characteristics, perioperative course, and postoperative outcomes. Continence was assessed using the 24 h pad weight test and patient-reported outcome measures (PROMs) were measured with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF). Follow-up over 10 years included re-intervention.

Results: Of 111 patients who underwent surgery between February 2008 and February 2012, 87 completed 10-year follow-up (median follow-up was 136.6 months (range:121.9-170.5). At 3-month follow-up, 59 patients (67.8%) were considered cured. Of the 59 patients initially cured, 17 patients (28.81%) lost continence during follow-up, 11 due to stress urinary incontinence recurrence (65%), four due to de novo urge incontinence (23%), and two due to salvage radiotherapy (12%). Of the 17 who lost continence, six received a second surgical treatment, with no reported intra or preoperative surgical problems due to the first surgery. In cured patients, surgery resulted in a reduction of the median ICIQ-SF score from 16.27 (SD 3.53) to 4.03 (SD 3.36) (p < 0.01). In the patients considered not cured, a reduction on the median ICIQ-SF score from 16.39 (SD 3.05) to 11.29 (SD 5.34) was observed (p < 0.01).

Conclusions: Our findings suggest that long-term continence rates after sling implant are acceptable, especially in ideal patients with mild to moderate incontinence and naïve for prior pelvic irradiation or surgical treatment for urinary incontinence or urethral stricture disease.