1. Clinical Efficacy and Patient Satisfaction of the New AdVance TM (Non Bone- Anchored) Male Sling Tarek Pacha 1, Darryl R.Reaume 2, Jon Suleskey 2, Jeff Schock 2 Henry Ford Macomb Hospital – Warren Campus 1,

2. Introduction Devastating!! 25-33% Management up to 1 year is conservative AUS Gold standard Morbid Technically challenging

3. Pt with mild incontinence <5 pads Better understanding of mid-urethral sling in women Development of Male sling Bone anchored Can have serious complications Non bone-anchored sling (2006)

4. Methods Prospective study Efficacy patient satisfaction/expectation UCLA PCI (urinary function section) questionnaire 14 patients by single surgeon Pre-Op: hx<5 pads, cysto, urodynamics Prostatectomy most common cause

5. Methods Position: Dorsal lithotomy and place foley Perineal incision Dissect to bulbospongiosus muscle and split in the midline Perform urethral dissection Pass the transobturator needle pass bilaterally Place sling and tension appropriately Close perineal wound Post-op: no heavy lifting for 4-6 wks

6. Mechanism of Action restore proper anatomical position to augment or assist external sphincter Proximal and cephalad displacement (3.5cm) Important: Pre-op sphincter function Circumferential coaptation

7. Final Position

8. Results 7 out of 11 patients (78.6%) who used 3 or more pads before surgery used 0-2 pads after surgery (p<.0082). Nine patients (64.3%) improved to either 1-2 pads or 0 pads. 7 out of 14 (50%) reported an improvement in bother. Over 50% of the patients were at least moderately satisfied and that the procedure met their expectations. No infections or erosions to date One patient with prolonged UR that required urethrolysis

9. Conclusions AdVance TM male sling encouraging option for mild-moderate UI Low morbidity How to optimize success rates? good patient selection appropriate pre-op work up. Limitation Longer follow-up vs AUS

10. Thank you! [1] Herr H. Quality of life in incontinent men undergoing radical prostatectomy. J Urol 1994;151:652-654 [2] Atul Rajpurkar, Rahmi Onur, Ajay Singla. Patient Satisfaction and Clinical Efficacy of the New Perineal Bone-Anchored Male Sling. European Urology 47(2005) 237-242 [3] UCLA Prostate Cancer Index [4] Urology Times: Using urethral slings to manage post-RP incontinence, 5/2008. [5] Nathan Ullrich, Craig Comiter. The Male Sling for Stress Urinary Incontinence: 24-Month Followup with Questionnaire Based Assessment [6] Peter Rehder and Christian Gozzi. Transobturator Sling Suspension for Male Urinary Incontinence Including Post-Radical Prostatectomy. European Urology 2007: 52: issue 3; 860-867.