Second-generation male sling beneficial at 5-year follow-up

The second-generation AdVance XP male sling system offered good mid-term results for the treatment of post-radical prostatectomy male stress urinary incontinence (SUI), researchers reported at the AUA annual meeting in Chicago.

“Many studies have shown that the AdVance sling is effective and safe in the treatment of post-prostatectomy incontinence,” said first author Jan-Niclas Mumm, a urology intern at Ludwig-Maximilians University Munich in Germany. The AdVance XP, which has been used in Europe for several years and recently became available in the United States, features longer arms and a new anchoring mechanism, as well as a reshaped introducer needle, which Mumm said improves its ease of use.

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The new study was a prospective trial including 115 patients; those with previous urinary incontinence surgery, previous radiotherapy, nocturnal urinary incontinence, and a functional urethra <1 cm in the preoperative repositioning test were excluded from the study. The authors used a strict definition of success for the device: A patient was considered cured if he used no pads and had 0 to 5 grams on a 24-hour pad test; he was considered improved if there was a reduction in urine loss of more than 50% in the 24-hour pad test. All other results were considered failures.

The median age in the trial was 69.0 years. Most men had undergone an open radical prostatectomy (75%), with fewer numbers undergoing robotic radical prostatectomy (14%) or a laparoscopic radical prostatectomy (11%). There was an average time between surgery and sling implantation of 29 months, and the mean urine loss at baseline was 341 g (median, 272.0 g) on the 24-hour pad test.

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