Sub-urethral sling Advance? midterm results: Patient selection and predictors of success [Bandelette sous-urétrale Advance?: Résultats à moyen terme: Sélection des patients et facteurs prédictifs]

摘要

Introduction and objectives: Sub-urethral trans-obturator male slings have been propose to treat men urinary incontinence. Medium term results are lacking: only one study has been published. Aim: To evaluate the efficacy of the sub-urethral sling Advance? (American Medical System, Minnetonka, MN, USA) and determinate factor of success. Materials and methods: Single center retrospective study of patients implanted with an Advance? for urinary incontinence after radical prostatectomy. The degree of incontinence was evaluated by number of pads used per days: mild (use of 1 to 2pads/day), moderate (3 to 4p/day) and severe (≥5p/day). The "Cure" was defined as no pad or just one for "security reason" and "improved" as decreased more than 50% of pads use. Results: Between October 2007 and November 2009, 69slings were implanted. Mean follow-up was 32.4months (±8.4months). Before treatment, 37.68% of the patients suffered from mild, 42.03% moderate and 20.29% severe urinary incontinence. At midterm, 21.8% of the patients were cured and 50.7% cured or improved. For patients who suffered from mild or moderate urinary incontinence, 23.6% were cured and 58.2% were cured or improved. The cure rate decreased with the severity of incontinence. It was respectively 30.8%, 17.2% and 14.2% for mild, moderate and severe incontinence. Failure rate was more important with severe incontinence: 78%. For patients with urethral fence pressure less than 57cmH2O, the risk of failure was multiply by 6.6. No severe complication was noted during follow-up. Only one male sling was removed. Conclusions: At midterm, one patient on five was cure and half was cured or improved. The technique presented an acceptable morbidity and a good tolerance. Two predictors of success were identified: severity of incontinence and residual sphincter function. Good candidates used less than three pads per day.