AdVance male sling in irradiated patients with stress urinary incontinence

Evaluate the complication rate and efficacy of the AdVance sling (American Medical Systems, Minnetonka, MN, USA) in patients with stress urinary incontinence (SUI) and a history of pelvic radiation.

A retrospective chart review of all men at our institution with a history of prostate cancer and subsequent radiation therapy treated with an AdVance sling for SUI.

Between 2007 and 2009 an AdVance sling was performed in 27 patients with prior pelvic radiation therapy. The mean patient age was 73.2 years. At an average follow up of 15.8 months 19 patients (70%) were claiming benefit from the operation. Average pre and postoperative pad use per day was 4.2 and 1.1, respectively. One patient had worsening symptoms, and two had no change. Intraoperative complications occurred in two patients (7.4%), both of which were urethral injuries during needle passage and both were repaired primarily and the procedure completed. Early complications included a urinary tract infection in one and urinary retention requiring intermittent catheterization in another. Two late complications occurred, including continued retention in the previously mentioned patient and hematuria (negative cystoscopy) in one of the patients with an intraoperative urethral injury. There were no mesh erosions or infections. Nine patients (38%) had some decreased efficacy over time and four patients underwent subsequent incontinence procedures.

The AdVance male sling can be safely and effectively performed in men who have had previous radiation therapy. Our results are encouraging but long term follow up is needed especially in light of the decrease efficacy in 38% of our patients.