Login to Access Video or Poster Abstract: MP46-15
Sources of Funding: none

Introduction

Although the AUS is still considered the gold standard for treatment of men with moderate or severe stress urinary incontinence (SUI), the transobturator male sling is a viable alternative for milder cases. We hypothesized that increasing selectivity of male sling patients improves clinical outcomes of the AdVance male sling procedure. We reviewed our 8 year experience with AdVance sling cases to determine the association of patient clinical characteristics and clinical outcomes over time at our institution.

Methods

We conducted a retrospective review of patients who underwent placement of the AdVance male sling for PPI between 2008 - 2015. Of those 231 patients identified, 166 had complete data for review including demographics and important pre-operative patient characteristics [pads per day (PPD), radiation history, time from cancer treatment, smoking, diabetes, hypertension, BMI, and physical demonstration of urine during Standing Cough Test (SCT) evaluation-determined as favorable (Grade 0-2) or unfavorable (Grade 3-4)]. We measured success post-operatively based on progression to further anti-incontinence surgery or lack of SUI improvement.

Results

Among 148 men who underwent AdVance sling placement with complete data available, 41(28%) failed during the mean follow up of 2 years. Median age and delay from prostate cancer treatment was similar between groups. Advance sling failure was associated with an increased PPD (median 2.5 [IQR 2-3.5] vs 1.5 [IQR 1-3]) (p=0.01). Those with unfavorable findings on SCT had a 50% failure rate, while those with favorable findings had a 25% failure rate (p=0.05). Patients with a history of XRT failed 63% of the time vs 23% who failed without radiation (p<0.0001). On multivariable analysis, each one pad increase in PPD (OR 1.46, 95%CI 1.10-1.94, p= 0.008), prior XRT (OR 6.59, 95%CI 2.36-19.56, p=0.0003), and unfavorable SCT (OR 4.04, 95%CI 1.11-15.59, p=0.03) were independently associated with sling failure. The addition of the SCT to the model significantly increased the ability to detect sling failure (AUC 0.77 vs 0.73).

Conclusions

Identifying patients with ideal characteristics preoperatively is associated with improved outcomes following AdVance male sling placement. Patients with a history of radiation and men found to have heavy leakage during standing cough test were at a significantly higher risk for failure of the sling. A model of prior XRT, PPD, and SCT evaluation had an improved selectivity for sling success.

Funding

none