Clinical overview of the AdVance® male sling in postprostatectomy incontinence
Context: Postprostatectomy stress incontinence can be treated with a number of nonsurgical and surgical methods. Urethral slings represent one of the less invasive surgical options, and a more recent addition to this class of devices is the nonobstructive transobturator sling, the AdVance® male sling. We provide a review of the clinical outcomes with this sling. Objective: To evaluate the literature on published clinical studies on the AdVance® sling in treating postprostatectomy incontinence. Evidence acquisition: We searched the PubMed database and evaluated all clinical studies on the AdVance® sling published from 2008 to 2010 involving a minimum of 35 patients. Evidence synthesis: The use of the AdVance® sling in postprostatectomy incontinence results in success rates of 54.6-90.6% up to 1 yr. Lower success rates are linked to poor patient selection, early part of the learning curve for the technique, and debatable definitions of success. The technique is durable, and success rates of 67.7-77% have been reported at 2 yr. One-hour and 24-h pad weight tests also reflect the efficacy of the technique, with significant reductions reported. The AdVance® sling is associated with significant improvements in patients' quality of life and satisfaction. Common adverse events include mild dysuria, perineal and scrotal pain, and urinary retention, all of which resolved completely in a short period of time. Conclusions: The AdVance® transobturator nonobstructive sling is an effective and safe treatment of postprostatectomy incontinence. Durable results have been reported in large patient series. The AdVance® transobturator sling is an effective and safe treatment option for men with postprostatectomy incontinence. Durable results out to 2 yr have been reported. Men selected for treatment are optimally those with mild to moderate incontinence and residual urinary sphincter function. © 2011 European Association of Urology.
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