PD37-04 ADVANCE XP® FOR THE TREATMENT OF POST-PROSTATECTOMY-INCONTINENCE: 5 YEAR DATA OF A PROSPECTIVE MULTICENTRE STUDY

Abstract

INTRODUCTION AND OBJECTIVES: In recent years, several studies have shown the effectiveness and safety of the AdVance sling (Boston Scientific, formerly American Medical Systems) for treating male stress urinary incontinence (SUI) after radical prostatectomy. In 2010 the second-generation AdVanceXP was introduced in Europe with highly useful changes in the sling configuration and needle design. In 2019 the AdVanceXP will be introduced also in the USA; Aim of this study was to evaluate the safety and effectiveness of the AdVance XP in a prospective multicentre long term follow-up study METHODS: 115 patients were included. Patients with previous urinary incontinence (UI) surgery, previous radiotherapy, nocturnal UI and a functional urethra < 1cm in the preoperative repositioning test were excluded. Postoperatively, a standardised 24-h pad test, qualityof- life scores [International Quality of Life score (IQOL) and International Consultation on Incontinence Questionnaire short form (ICIQ-UI SF)], visual analogue scale (VAS) for pain, five-item version of the International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS) and Patient Global Impression of Improvement (PGI-I) score were carried out. The patient collective defined as cured were those patients with a pad test < 0-5 g. The patient group described as improved showed a reduction of urine loss of >50%. All others were classified as failures. Significance analysis was performed using the Wilcoxon test. RESULTS: The mean preoperative urine loss in the 24-h pad test was 341g (median 272.0 g). After a follow-up of 24 months (102 patients), 66.7% of the patients were cured and 26.5% had improved. The mean urine loss decreased significantly to 18.6 g (P < 0.001), with a mean VAS score of 0.3, and mean PGI-I of 1.5. After a followup of 48 months (60 patients), 71.7% of the patients were cured and 15.0% had improved. The mean urine loss decreased significantly to 24.4g (P < 0.001), with a mean VAS score of 0.1, and mean PGI-I of 1.4. The mean IQOL and ICIQ-UI SF improved significantly (both P < 0.001). After a follow-up of 60 months (36 patients), 61.1% of the patients were cured and 19.4% had improved. The mean urine loss decreased significantly to 24.2 g (P < 0.001), with a mean VAS score of 0.2, and mean PGI-I of 1.6. The mean IQOL and ICIQ-UI SF improved significantly (both P < 0.001) after 60 months. There were no significant postoperative changes in IIEF-5 and IPSS. No intraoperative and no long-term complications occurred. No erosion or explantation occurred. Due to a presumable intraoperative overcorrection of the sling during Repositioning or/and Tyvek-cover removal, six patients (5.2%; n=115) showed persistent postoperative residual urine. In these patients dissection of one sling arm was necessary. In result, the operation technique in further procedures was adjusted. Later on, no additional cases with residual urine occurred. CONCLUSIONS: The 5 years follow up results show a good continence rate and demonstrate a stable effectiveness over the years, low complication rates and considerably improved quality life scores in the use of the AdVance XP.