Hanhan Li1, Bradley C. Gill1, Amy S. Nowacki1, Drogo K. Montague1,2, Kenneth W. Angermeier1,2, Hadley M. Wood1,2, and Sandip P. Vasavada1,2
1Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
2Glickman Urological and Kidney Institute, Cleveland Clinic Foundation
Abstract
The male transobturator AdVance sling is currently being utilized for mild to moderate post-prostatectomy incontinence (PPI). We wanted to determine the mid-term patient reported outcomes through a telephone survey and chart-review.
Our results demonstrate that from initial office visit to 2 years, quantitative success declined by 25% and pad use doubled from 0.8±1.7 to 1.7±2.5 pads per day (PPD). Patient-determined success was 53.6% at 2 years. A subgroup of 25 patients interviewed at 7 and 29 months post-sling had quantitative success significantly decrease by 20% (p=0.03), subjective success decline by 4% (p=0.56), and pad use significantly increase (p=0.01) from 1.4±2.2 to 2.3±3.2 PPD. Although a majority of patients receiving the AdVance sling did see improvement in PPI and a decrease in pad use, 20% had worsened efficacy over time. Despite this, patients remained satisfied and perceived their treatment as successful.
The following tables are supplemental to the manuscript currently in press at the Journal of Urology.
Charted Baseline Characteristics
| |
n |
median (Q1-Q3) |
mean (sd) |
| Age |
66 |
66.3 (62.3-72.7) |
66.7 (8.3) |
| Body mass index (kg/m2) |
66 |
26.7 (24.6-29.3) |
27.3 (3.8) |
| Time from prostatectomy to sling (mos) |
66 |
22.9 (12.9-72.8) |
50.5 (54.9) |
| Charted pre-sling pads/day |
62 |
2 (1-3) |
2.8 (2.3) |
| |
|
|
|
| 24-Hr pad wt (gm) |
26 |
148 (60-367.3) |
233.0 (214.0) |
| P Det at Q Max |
36 |
22.5 (11.3-33.8) |
27.3 (21.8) |
| Bladder capacity (ml) |
43 |
345 (287-400) |
356.6 (102.0) |
| Max flow pressure (cm H2O) |
44 |
13.5 (9.0-20.5) |
17.0 (11.7) |
| Valsalva leak point (cm H2O) |
36 |
75.5 (52.5-110.5) |
91.4 (54.9) |
| Volume at leakage (ml) |
37 |
285 (199.5-311.5) |
275.4 (107.3) |
| |
|
|
|
| |
n |
no. pts (%) |
|
| Type of incontinence |
66 |
|
|
| Stress |
|
53 (80.3) |
|
| Mixed |
|
12 (18.2) |
|
| Etiology of incontinence |
66 |
|
|
| Radical prostatectomy |
|
65 (98.5) |
|
| Laser TURP |
|
1 (1.5) |
|
| Prostatectomy type |
66 |
|
|
| None |
|
1 (1.5) |
|
| Open |
|
30 (45.4) |
|
| Lap/robotic |
|
29 (43.9) |
|
| Perineal |
|
1 (1.5) |
|
| Unknown |
|
5 (7.6) |
|
| Radiation history (EBRT) |
66 |
4 (6.1) |
|
| Cancer free |
66 |
61 (92.4) |
|
| Previous incontinence treatment |
66 |
|
|
| AUS |
|
5 (7.6) |
|
| Clamp |
|
5 (7.6) |
|
| Medications |
|
20 (30.2) |
|
| Kegels |
|
19 (28.8) |
|
| Periurethral collagen |
|
7 (10.6) |
|
| Bone-anchored sling |
|
1 (1.5) |
|
| Erectile dysfunction |
64 |
60 (93.8) |
|
| Sexually active |
63 |
42 (66.7) |
|
| Smoking history |
66 |
30 (45.5) |
|
Baseline demographic data was obtained via chart review. In summary, 66 patients (mean age 67, BMI 27) received the sling at a median 23 months post-prostatectomy. Median baseline charted pad use was 2(1-3) PPD.
Surgeon Experience
| |
First 10 mean (sd) |
Last 10 mean (sd) |
p Value |
| Age |
64.4 (11.3) |
64.7 (7.3) |
0.97 |
| BMI |
25.7 (2.7) |
29.2 (5.3) |
0.19 |
| Charted pre-sling pads/day |
2.3 (1.0) |
1.9 (1.0) |
0.41 |
| |
|
|
|
| Chart |
mean (sd) |
mean (sd) |
p Value |
| Time since sling to most recent office visit (mos) |
1.5 (1.0) |
1.6 (0.4) |
0.10 |
| Charted post-sling pads/day |
0.4 (0.5) |
0.4 (1.0) |
0.48 |
| |
|
|
|
| |
no. pts |
no. pts |
p Value |
| Quantitative cure (0 pads/day) |
6 |
8 |
0.63 |
| Quantitative improvement (1-2 pads/day) |
4 |
0 |
0.09 |
| Quantitative success (cure and improved) |
10 |
8 |
0.47 |
| |
|
|
|
| Surveys |
Survey 1 |
Survey 2 |
p Value |
| Time from sling to survey (mos) |
10.0 (4.2) |
13.2 (3.5) |
0.05 |
| Surveyed pre-sling pads/day |
2.4 (1.1) |
2.1 (1.3) |
0.64 |
| Surveyed post-sling pads/day |
1.2 (1.1) |
0.4 (0.7) |
0.11 |
| Mean change in pads/day |
1.1 (1.2) |
1.5 (1.1) |
0.51 |
| |
|
|
|
| |
no. pts |
no. pts |
p Value |
| Refer a friend |
4 |
7 |
0.37 |
| Quantitative cure (0 pads/day) |
4 |
7 |
0.37 |
| Quantitative improvement (1/2 pads/day) |
4 |
1 |
0.30 |
| Quantitative success (cure and improved) |
8 |
8 |
1 |
| Subjective success (PGI-I very much and much better) |
5 |
7 |
0.65 |
Surgeon experience was analyzed using the first and last 10 cases of the surgeon with the greater number of patients. No significant differences were noted in pre-sling PPD (pads per day), post-sling PPD, change in mean PPD, willingness to refer the procedure to a friend, quantitative success, or subjective success.