Salvage therapy with artificial urinary sphincter after Advance™ male sling failure for post-prostatectomy incontinence: A first clinical experience

Objectives. - To assess the clinical outcome following artificial urinary sphincter (AUS) implantation after failure of Advance (TM) sub-urethral male sling for post-prostatectomy incontinence (PPI). Methods. - A prospective evaluation was conducted about consecutive patients who received an AUS after failure of Advance (TM) therapy in one tertiary reference center. Evaluation included medical history, pad use and operative data (duration, cuff size, technical difficulties). Followup was scheduled at 1, 6, 12 months and yearly thereafter. Clinical outcome was evaluated by pad use, patient global impression of improvement (PGI-I) scale and assessment of side effects. Cure was defined as no pad usage. Results. - Twelve patients were included in this evaluation. Median follow-up was 20 months (12-43). No patient was lost to follow-up. Four patients had a history of radiation therapy and all patients had mild or moderate PPI with previous failed Advance (TM) surgery. Median (range) operative time was 47 minutes (40-60). No technical problem occurred during AUS implantation. Hospital stay duration and catheterization duration were respectively 2 days and 24 hours in all but one case. At last follow-up, 10/12 patients (83%) were cured and fully satisfied. Two were improved, wearing only one pad per day. Postoperative complications were noted in two cases (17%) (one case of cutaneous erosion and one case of superficial iliac wound infection). Conclusions. - AUS implantation is feasible in patients who have undergone Advance (TM) male sling implantation. Mid-term results of this procedure are comparable to those obtained after first line AUS implantation. (C) 2012 Elsevier Masson SAS. All rights reserved.