The AdVance® Male Sling: Anatomic Features in Relation to Mode of Action  Dirk De Ridder, Peter Rehder  European Urology Supplements  Volume 10, Issue 4, Pages 383-389 (July 2011) DOI: 10.1016/j.eursup.2011.04.001 Copyright © 2011 European Association of Urology Terms and Conditions

Fig. 1 Composite drawings of the organisation of the posterior support, showing the joint insertion of the puboperineal muscles, rectourethralis muscle, and the midline raphe of the rhabdosphincter at the level of the conjoined fibrous tissue. The inferior part of Denonvillier's fascia inserts at this level: (a) coronal view, (b) lateral view. European Urology Supplements 2011 10, 383-389DOI: (10.1016/j.eursup.2011.04.001) Copyright © 2011 European Association of Urology Terms and Conditions

Fig. 2 Magnetic resonance imaging shows a changed anatomic relationship between puboperineal muscles and the membranous urethra postprostatectomy. European Urology Supplements 2011 10, 383-389DOI: (10.1016/j.eursup.2011.04.001) Copyright © 2011 European Association of Urology Terms and Conditions

Fig. 3 Cadaver dissection. Through a perineal approach, the bulbar urethra has been removed and the apical prostate and membranous urethra can clearly be seen. The rectourethralis muscle has been removed. A few millimetres proximal to the rectourethralis muscle, the puboperineal muscle forms a posterior sling. European Urology Supplements 2011 10, 383-389DOI: (10.1016/j.eursup.2011.04.001) Copyright © 2011 European Association of Urology Terms and Conditions

Fig. 4 (a) Anterior–posterior view of the urethral bulb as seen by the surgeon, with the patient in the lithotomy position. The bulbous spongiosum can be seen with the AdVance® sling approximated onto it. The line indicates the transverse fold of the middle portion of the sling when it is tensioned. (b) Lateral view of the bladder and the urethra with the AdVance® sling approximated onto the urethral bulb before tensioning. The short zone of urothelial coaptation can be appreciated within the membranous (sphincteric) urethra. The arrow indicates the direction of movement when the sling is tensioned. (Lateral image based on magnetic resonance imaging conducted by P.R.). (Copyright P. Rehder.) European Urology Supplements 2011 10, 383-389DOI: (10.1016/j.eursup.2011.04.001) Copyright © 2011 European Association of Urology Terms and Conditions

Fig. 5 Lateral view of the bladder and the urethra with the AdVance® sling tensioned, leading to repositioning of the urethral bulb. The sling has folded on itself and acts as a support to the distal membranous (sphincteric) urethra. This leads to better luminal coaptation within the membranous urethra and an increase in functional urethral length. The arrow indicates the direction of movement when the sling is tensioned. (Image based on magnetic resonance imaging and changes in the zone of luminal coaptation based on intraoperative urethroscopy conducted by P.R.). (Copyright P. Rehder.) European Urology Supplements 2011 10, 383-389DOI: (10.1016/j.eursup.2011.04.001) Copyright © 2011 European Association of Urology Terms and Conditions