Introduction

The AdVanceXP transobturator male sling has been introduced in 2010 and includes several innovative features. However, there is still limited data about its impact on perioperative safety. In the current comparative study, we analyze perioperative complication rates and short-term re-hospitalization rates after AdVance as well as AdVanceXP implantation in a large multi-center patient cohort.

Methods

294 male patients with stress urinary incontinence (SUI) underwent primary implantation of AdVance (AdV: n=109) or AdVanceXP (XP: n=185) transobturator male sling between 2010 and 2012 in 11 international continence reference centers. Approval by a local ethics committee was obtained. Perioperative characteristics and postoperative complications were analyzed. Complications were classified using the Clavien-Dindo scale. 6-months re-hospitalization rates were assessed. Pre-defined risk factors for the total postoperative complication rate were assessed. For univariate analysis and between-group comparison, univariate ANOVA, Fisher’s exact test and students t-test were used. A p value below 0.05 was considered statistically significant.

Results

Both subgroups did not vary significantly in preoperative pad usage [3.8 (AdV) vs. 3.6 (XP); p=0.506]. There were no intraoperative complications. Overall postoperative urinary retention rate was 7.9% [4.2% (AdV) vs. 9.9% (XP); p=0.103]. Postoperative inguinal or perineal pain was stated in 1.5% [2.0% (AdV) vs. 1.2% (XP); p=0.628]. De-novo urgency rate was 4.6% [8.4% (AdV) vs. 2.4% (XP); p=0.032]. Any kind of postoperative infection was observed in 1.9% [2.1% (AdV) vs. 1.8% (XP); p=1.000]. Short-term device dislocation rate was 2.9% [4.6% (AdV) vs. 1.8% (XP); p=0.269]. Overall short-term re-hospitalization rate (within 6 months) was 4.2% [3.8% (AdV) vs. 4.4% (XP); p=1.000]. There was no postoperative bleeding, urethral erosion, and impaired wound healing. Total postoperative complication rates were 16.7% (AdV) and 15.7% (XP) respectively (p=0.863). There were no Clavien 4 or 5 complications. Univariate analysis showed no significant influence of history of pelvic irradiation, urethral stricture, preoperative pad usage, body-mass-index and age.

Conclusions

In the current study, we provide comparative data from a large multi-institutional patient cohort. Complication profiles vary between the AdVance and AdVanceXP transobturator male slings. AdVanceXP implantation leads to significantly decreased de-novo urgency rates, decreased device dislocation rates, and increased urinary retention rates, the latter ones without reaching statistical significance. Both AdVance and AdVanceXP implantation are safe procedures.