1522 LARGE VOLUME PAD WEIGHT IS PREDICTIVE OF FAILURE IN TREATING POST PROSTATECTOMY INCONTINENCE WITH THE ADVANCE SLING

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You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy I1 Apr 20101522 LARGE VOLUME PAD WEIGHT IS PREDICTIVE OF FAILURE IN TREATING POST PROSTATECTOMY INCONTINENCE WITH THE ADVANCE SLING Kristy Borawski, Daniel Rapoport, and George Webster Kristy BorawskiKristy Borawski Durham, NC More articles by this author , Daniel RapoportDaniel Rapoport Vancouver, Canada More articles by this author , and George WebsterGeorge Webster Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2366AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Appropriate patient selection is important in determining outcomes in treating post prostatectomy incontinence with the Advance sling. We reviewed our database of men treated with the Advance sling to see what factors were predictive of failure. METHODS We retrospectively reviewed the records of 181 men who underwent placement of an Advance sling from January 2006 – September 2009. Pre-operative radiation, incontinence parameters, sphincter appearance and urodynamic data were reviewed. Primary outcomes were success, defined as significant improvement requiring only 1 pad for protection for stress incontinence with major activities, and continence, defined as the absence of incontinent episodes without the need for pads. RESULTS Of the 181 men, 180 had a prostatectomy (59 robotic), 1 had a greenlight laser prostatic resection while 11 had prior radiation. The average age was 65 with a mean follow-up of 5 months. The mean pre-operative pad weight (PPW) was 331 grams (range 12-1133 grams) with 20% of the men with a pre-operative pad weight of >500grams. Overall, 73.5% (133/181) were successful, while 57.5% (104/181) were continent. Of those who were not continent, 69% had a >50% improvement in their 24 hour pad weight Multivariable logistic regression was then used to determine factors associated with failure. Subjects with a PPW >500 grams were 7.3 (95% CI 2.8 – 19.0) and 4.1 (95% CI 1.7 – 9.8) times respectively more likely to be unsuccessful and incontinent compared to subjects with pad weight <200 grams. Although it appeared as if the presence of poor volitional copaton of the sphincter was predictive of failure (success, OR 1.76 [95% CI 0.59 – 5.3, p=0.3)] continence OR 2.44 [95% CI 0.85 – 7.0, p=0.09] it did not achieve significance. Additionally, the absence of a scarred sphincter appeared to be protective and associated with better continence and success rates (success OR 0.5 [95% CI 0.17 – 1.5, p=0.2]; continent OR 0.37 [95% CI 0.13 – 1.09, p=0.07] however it did not reach significance. When looking at our “ideal candidate,” one with an intact sphincter (no scars, clefts) that is closed at rest who can volitionally contract the sphincter and no radiation exposure, those subjects had an 89% success rate and a 74% continence rate CONCLUSIONS The Advance sling remains an option in treating post prostatectomy urinary incontinence. Higher PPW, the inability to volitionally coapt the sphincter and the presence of a scarred sphincter are associated with decreased cure rates. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByAjay D, Zhang H, Gupta S, Selph J, Belsante M, Lentz A, Webster G and Peterson A (2018) The Artificial Urinary Sphincter is Superior to a Secondary Transobturator Male Sling in Cases of a Primary Sling FailureJournal of Urology, VOL. 194, NO. 4, (1038-1042), Online publication date: 1-Oct-2015.Lentz A, Peterson A and Webster G (2018) Outcomes Following Artificial Sphincter Implantation After Prior Unsuccessful Male SlingJournal of Urology, VOL. 187, NO. 6, (2149-2153), Online publication date: 1-Jun-2012. Volume 183Issue 4SApril 2010Page: e587 Advertisement Copyright & Permissions© 2010 by American Urological Association Educat