Introduction and Objectives
The rationale of the Advance® Sling System in male stress urinary incontinence does not rely on the principle of compressing the urethra and the bladder neck but on an anatomical repositioning of the urethral bulb into the pelvic floor. Previous studies have shown that radical prostatectomy (RPX) often leads to a descend of the bulbar part of the urethra into the lower pelvis resulting in a lower closure pressure of the external urethral sphincteric muscle. The aim of the therapeutical concept of the advance-sling is to suspend the dorsal part of the urethra with a transobturatory sling which is lifting the urethra in order to regain full function of the sphincteric muscle. The urethra therefore is elevated in a dorso-cranial direction towards the pubic symphysis without being compressed by the sling.
Material and Methods
25 Patients with mild to moderate Stress urinary incontinence (ICSII°) following RPX with an intact sphincteric muscle were treated with this system. The following data were checked preoperatively, 24 h postoperatively and 12 weeks postoperatively: −24 h Pad Test – Urinalasys – Kings Health Questionnaire – EORTC QLQ C30 PR25 - Urodynamic studies.
Results
The average pad-usage in 24 h was reduced from 4.2 preoperatively to 1.2 postoperatively, shown in the ICS Pad Test. This is highly significant with a p-value of <0.001 in the ANOVA Test. The urinary symptoms in the EORTC PR 25 module were reduced from 27 to 7.2 in the 12 weeks follow-up. (pvalue <0.002). Urodynamic studies did not show any significant increase in the parameters of obstruction during micturation in the 12 weeks follow-up.We had no major or minor complication in the peri- and postoperative phase.
Conclusions
The Advance® male-sling-System significantly reduced urinary symptoms as well as pad usage. It is a simple and safe procedure and therefore offers a good treatment option in male stress urinary incontinence after radical prostatectomy
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
