What is the place of the Artificial Urinary Sphincter in 2012? Introduction There are an increasing array of surgical options for the treatment of post-prostatectomy incontinence, including bulking agents, peri- urethral balloons and a variety of male sub-urethral slings. We have reviewed the results of men treated with AdVance® slings or artificial urinary sphincters (AUS) in order to better define the indications for these respective procedures and predict optimal clinical outcomes. Conclusions  AdVance® slings offer a safe, effective treatment of mild-mod post- prostatectomy continence with the vast majority of men remaining improved in the medium term, although the pad-free rate declines over time, particularly in irradiated men  AUS remains the most effective treatment for severe post- prostatectomy stress incontinence, with high satisfaction rates even though most men still use a pad when validated questionnaires used  Urethral strictures are more common after radiotherapy and often cannot be stabilised, however can still be maintained through an AUS or AdVance® sling Results – outcomes Peri-operative complications  AdVance® sling - 14 (25.9%) temporary urinary retention, 2 (3.7%) lasting more than two weeks and requiring cystoscopy/dilatation - 2 (3.7%) transient hip pain resolving spontaneously - No pelvic haematoma or sling infection  AUS (Approach 11 [23.4%] perineal, 36 [76.6%] penoscrotal) - 1 (2.1%) infection requiring explantation - 1 (2.1%) scrotal haematoma - 1 (2.1%) urethral injury - 1 (2.1%) pulmonary embolism Functional outcomes – AdVance® sling  50 men (92.6%) immediately pad-free  Mean F/U 9.7 mths (1-36)  At follow-up - 40/52 (76.9%) men with mild-mod incontinence pad- free vs 0/2 men with severe Incontinence  Of those men with prior RT 4/7 (57.1%) pad-free  Of those men with minimum 12 mth F/U (mean 21.6, 12-36mth) - mild-mod incontinence (n=14): All improved, 9 (64%) pad-free, - severe incontinence (n=2): 1 improved, 1 failed and had AUS Functional outcomes – Artificial urinary sphincter  Mean F/U 23 months (3-60)  AUS revision rate 17% - Early: 4 (8.5%) tandem cuff for persisting incontinence - Late: 4 (8.5%), 1 erosion, 1 mechanical failure, 2 cuff atrophy Methods  Peri-operative data of consecutive patients operated on for post- prostatectomy incontinence by a single surgeon were recorded on a prospective database  Short and medium-term outcomes were reviewed  Patients who had undergone insertion of an artificial urinary sphincter were asked to complete a questionnaire amalgamated from 4 validated existing instruments: the international Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Post- Operative Global Impression of Improvement (PGI-I), Incontinence Impact Questionnaire- Short Form (IIQ-SF) and Urogenital Distress index (UDI-SF)  Level of incontinence was defined as: Mild (1 pad/day or 3 pads/day or >400ml pad weight) Aim To evaluate peri-operative and functional outcomes of men undergoing surgery for post-prostatectomy incontinence To assess short-medium term results of the artificial urinary sphincter and AdVance® suburethral sling and their relative roles in the management of post-prostatectomy incontinence Figure 1. Continence outcomes for all men at mean F/U 9.7mth after AdVance sling. 74% pad free, 22% requiring a pad but improved, 4% recurrent incontinence Figure 2. Continence outcomes at mean 23 mth after I/O AUS Dr Daniel Moon and Ms Kay Talbot Australian Urology Associates, Melbourne, Victoria Poster presentation sponsor No. 057 Results – pre-operative  101 men underwent surgery between ; 47 underwent insertion of AUS and 54 an AdVance® sling  The AdVance® sling was generally only offered to patients with mild- mod incontinence, only 2 being inserted for patients with more significant leakage  Of patients with severe incontinence undergoing AUS: - Mode of RP: 53% open, 45% robotic, 2% lap - Prior radiotherapy was predictive of co-existing stricture – present in 53.8% of irradiated men vs 8.8% who had undergone surgery alone AdVance® sling (n=54) Age67 (54-84) Prior bulking agent 5 (9.3%) Prior RT7 (12.9%) Incontinence: Mild26 (48.1%) Moderate26 (48.1%) Severe2 (3.7%) AUS (n=47) Age68 (58-85) Prior surgery Macroplastiqu e 18 (15 men) 9 (19.1%) ProACT2 (4.3%)* Sling3 (6.4%) AUS5 (10.6%)# Prior RT13 (27.7 %) Stricture10 (21.3%) * 1 eroded # 2 eroded Table 1. Pre-operative patient parameters Figure 3. Quality of life measures post AUS 26%26% 67%67% 2%2% 5%5%