Adjustable versus non‐adjustable male sling for post‐prostatectomy urinary incontinence: A prospective clinical trial comparing patient choice, clinical outcomes and satisfaction rate with a minimum follow up of 24 months

Chung, Eric; Smith, P. J.; Malone, Greg; Cartmill, Ross

doi:10.1002/nau.22731

Cited by 32 publications

(26 citation statements)

References 17 publications

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“…The majority of previous studies assess the success of the AdVance sling using improvement in daily pad use and quality of life questionnaires . Recently, two small Australian series have reported on the outcomes of the AdVance sling . Habashy et al .…”

Section: Discussionmentioning

confidence: 99%

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AdVance male urethral sling: medium‐term results in an Australian cohort

Papachristos

Mann²,

Talbot³

et al. 2017

ANZ Journal of Surgery

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Background Since 2008, the AdVance male urethral sling has emerged as a minimally invasive option for stress urinary incontinence. We aimed to evaluate the success of the AdVance sling using validated continence outcome measures. Methods A total of 72 patients treated with the AdVance sling completed validated questionnaires reporting on quality of life and functional outcomes. Incontinence was assessed according to pad weight, pad usage per day (PPD), International Consultation on Incontinence Questionnaire scores and Patient Global Impression of Improvement scores. Results At a median 52‐month follow‐up, 37 (51%) patients were pad free or used a security pad; 18 (25%) used ≥50% fewer PPDs; and the remaining 17 (24%) patients were classified as ‘failed’. According to pad weights, 27 (38%) patients were dry; 32 (44%) had mild incontinence (<100 mL/day); and 13 (18%) had moderate (100–400 mL/day) or severe (>400 mL/day) incontinence. Patient satisfaction was high, with 57 (79%) very much or much better, six (8%) somewhat better and only nine (13%) unchanged or worse. There was a trend of declining continence over time, although the majority remained improved. Patients with severe preoperative incontinence performed significantly worse postoperatively (P = 0.02), as did those who had had prior pelvic radiotherapy (P = 0.02). Conclusions The AdVance sling offers a high rate of success for the treatment of mild to moderate post‐prostatectomy incontinence according to PPD; however, when using objective measures of continence, the success rates are lower. The improvement in urinary control is largely durable over the medium term; however, they may decline beyond 4 years. Reduced efficacy is seen in those with a history of radiotherapy and severe incontinence, although the majority of these men are still improved with surgery.

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Section: Discussionmentioning

confidence: 99%

“…Similarly, Chung et al . reported that 16 of 19 men treated with the AdVance sling achieved social continence (0 or 1 PPD) at a mean follow‐up of 33 months …”

Section: Discussionmentioning

confidence: 99%

AdVance male urethral sling: medium‐term results in an Australian cohort

Papachristos

Mann²,

Talbot³

et al. 2017

ANZ Journal of Surgery

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“…Chung et al 11 analyzed outcomes as well as patients' decisions of 44 patients who were offered adjustable or fixed male slings due to persistent stress urinary incontinence. Interestingly, a majority of patients (57%) chose the adjustable ARGUS classic male sling, most probably because of the appealing opportunity to increase continence rates by repeated adjustments as hypothesized by the authors.…”

Section: Discussionmentioning

confidence: 99%

Retropubic vs transobturator Argus adjustable male sling: Results from a multicenter study

Loertzer

Huesch

Kirschner‐Hermanns

et al. 2020

Neurourology and Urodynamics

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Aims To comparatively analyse outcomes after ARGUS classic and ArgusT adjustable male sling implantation in a real‐world setting. Methods Inclusion criteria encompassed: non‐neurogenic, moderate‐to‐severe stress urinary incontinence (≥2 pads), implantation of an ARGUS classic or ArgusT male sling between 2010 and 2012 in a high‐volume center (>150 previous implantations). Functional outcomes were assessed using daily pad usage, 24‐hour pad testing, and International Consultation on Incontinence (ICIQ‐SF) questionnaires. Continence was defined as zero pads per 24 hours. Complications were graded using Clavien‐Dindo scale. For multivariate analysis, binary logistic regression models were used (P < .05). Results A total of 106 patients (n = 74 [ARGUS classic], n = 32 [ArgusT]) from four centers were eligible. Median follow‐up was 44.0 months (24‐64). Patient cohorts were well‐balanced. We observed a statistical trend in favor of ARGUS classic regarding postoperative urine loss based on standardized 24‐hour pad test (71 ± 162 g [ARGUS classic] vs 160 ± 180 g [ArgusT]); P = .066]. Dry rates were 33.3% (ARGUS classic) and 11.8% (ArgusT, P = .114). In multivariable analysis, ArgusT male sling could not be confirmed as an independent predictor of decreased success (OR, 0.587; 95% CI; 0.166‐2.076, P = .408). There were no Clavien IV and V complications. Inguinal pain was significantly higher after ArgusT implantation (P = .033). Explantation rates were higher for ArgusT compared to ARGUS classic (14.0 vs 23.3%; P = .371). Longer device survival for the ARGUS classic male sling was observed in Kaplan‐Meier analysis (P = .198). Conclusions In the largest comparative analysis of ARGUS classic and ArgusT male sling with the longest follow‐up to date, we observed low continence rates with superior functional outcomes and decreased explantation rates after ARGUS classic implantation.

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“…The adjustable MS has a theoretical advantage over non-adjustable MS because the sling can be revised easily to provide further urethral compression in the event of persistent and/or recurrent urinary incontinence without the need for another MS or salvage AUS surgery. Chung reported that more men chose adjustable over non-adjustable MS when given the options despite no significant difference observed in the clinical outcomes and similar patient satisfaction rate (14). …”

Section: Methodsmentioning

confidence: 99%

Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery

Chung¹

2017

Transl. Androl. Urol.

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Male stress urinary incontinence (SUI) remains a debilitating condition that adversely impacts all domains of quality of life and is associated with significant social stigma and health economic burden. The incidence of post-prostatectomy urinary incontinence (PPI) depends on the definition of urinary incontinence and the length of patient follow up. In patients with persistent PPI following failure of conservative measures, surgical treatment is recommended although there is no published guideline on when surgery should be performed, and what the best surgical option is. Male slings (MS) can be divided into adjustable or non-adjustable types, and offers an attractive option for patients who wish to avoid mechanical handling during urinary voiding. Published intermediate data supports good safety and efficacy rate in men with mild to moderate degree of SUI. The AMS 800 artificial urinary sphincter (AUS) remains the standard of treatment for complete continence and has the longest efficacy and safety records. Other AUS-like devices are designed to address current AMS 800 limitations but themselves are fraught with their own issues.

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Adjustable versus non‐adjustable male sling for post‐prostatectomy urinary incontinence: A prospective clinical trial comparing patient choice, clinical outcomes and satisfaction rate with a minimum follow up of 24 months

Cited by 32 publications

References 17 publications

AdVance male urethral sling: medium‐term results in an Australian cohort

AdVance male urethral sling: medium‐term results in an Australian cohort

Retropubic vs transobturator Argus adjustable male sling: Results from a multicenter study

Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery

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