The AdVance® male sling: Patient selection and workup
The AdVance® male sling (American Medical Systems, Minnetonka, MN, USA) is a retrourethral transobturator sling that offers an effective surgical approach for the treatment of postprostatectomy stress urinary incontinence (SUI). Clinical studies have demonstrated success rates of 80-90% at 1-yr follow-up. The most appropriate candidate patients for the AdVance® sling may be those with mild to moderate incontinence, but success rates may not be markedly lower in patients with severe incontinence. Clinical experience with the AdVance® sling suggests that cystoscopically confirmed residual sphincter function is an important requirement for good outcome. Assessment of SUI should be modified to include a consideration of sphincter function in addition to the currently accepted definitions of incontinence severity (pad weight and number). The AdVance® male sling may be considered a first-line surgical treatment as well as a salvage treatment for some patients who have failed previous surgical treatment. More data are needed to better understand the patient-related factors that affect the short- and long-term outcomes of this minimally invasive treatment for male SUI. Patient selection for the AdVance® sling should be based on residual sphincter function and mobility of the membranous urethra in conjunction with mild to moderate incontinence. Patients with severe incontinence may be treated, but success rates may be lower. © 2011 European Association of Urology.
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