AdVance® Male Sling: Surgical Technique and Postoperative Patient Management  Kurt McCammon, François Haab  European Urology Supplements  Volume 10, Issue 4, Pages 395-400 (July 2011) DOI: 10.1016/j.eursup.2011.04.006 Copyright © 2011 Terms and Conditions

Fig. 1 Optional marking of the origin of the central tendon on the proximal bulb before dissecting the proximal bulb off the central tendon. European Urology Supplements 2011 10, 395-400DOI: (10.1016/j.eursup.2011.04.006) Copyright © 2011 Terms and Conditions

Fig. 2 Central tendon identification before dissection. European Urology Supplements 2011 10, 395-400DOI: (10.1016/j.eursup.2011.04.006) Copyright © 2011 Terms and Conditions

Fig. 3 Insertion of the AdVance® helical needle. A finger is placed through the puncture below the ischiopubic ramus to protect the urethra and guide needle placement. Then the needle is driven straight in through the puncture. European Urology Supplements 2011 10, 395-400DOI: (10.1016/j.eursup.2011.04.006) Copyright © 2011 Terms and Conditions

Fig. 4 Continuing insertion of the AdVance® helical needle following the initial placement through the puncture. Two pops should be felt, and after the second pop, the needle is adjusted by an approximate one-quarter turn. European Urology Supplements 2011 10, 395-400DOI: (10.1016/j.eursup.2011.04.006) Copyright © 2011 Terms and Conditions

Fig. 5 Attachment of the AdVance® sling to the corpus spongiosum. Two sutures are placed proximally and two distally to the sling through the corpus spongiosum. (a) Actual surgical procedure; (b) diagrammatic representation. European Urology Supplements 2011 10, 395-400DOI: (10.1016/j.eursup.2011.04.006) Copyright © 2011 Terms and Conditions

Fig. 6 Tensioning of the AdVance® sling. (a) Actual surgical procedure; (b) 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 was tensioned. (Image based on magnetic resonance imaging and changes in the zone of luminal coaptation based on intraoperative urethroscopy conducted by P.R.). European Urology Supplements 2011 10, 395-400DOI: (10.1016/j.eursup.2011.04.006) Copyright © 2011 Terms and Conditions