Treatment of postoperative male urinary incontinence by INVANCE® prosthesis:: preliminary results.

Purpose: To evaluate the preliminary results of treatment of postoperative male stress urinary incontinence (SUI) by the INVANCE(R) (AMS) suburethral sling. Material and Methods: From June 2003 to May 2004, 22 patients with stress urinary incontinence secondary to prostatic surgery (13 radical prostatectomies, 7 Ablatherm(R), 2 transurethral resections of the prostate) were treated by INVANCE(R) sling. The patients presented either grade 1 incontinence (1 to 2 pads per day), or grade 2 incontinence (3 to 4 pads per day), or grade 3 incontinence (5 or more pads per day). The INVANCE(R) process uses a rectangular polyester sling positioned under the bulbar urethra via a perineal incision. It is attached to the 2 ischiopubic ram by 3 titanium screws using a disposable electric screwdriver Patients were reviewed every 3 months to evaluate the results (continence, Qmax, post-voiding residual volume, IPSS score, quality of life) Results: The mean duration of the procedure was 79 minutes (range: 60-120). No intraoperative incidents were observed. The bladder catheter was removed on D1 (n=20) or D2 (n=2). The mean length of stay was 3.3 days (range: 2-8). Complications consisted of perineal haematoma (n=1), acute urinary retention after catheter removal (n=4), sling infection requiring removal (n=1), and prolonged perineal pain (n=5). No de novo irritative or obstructive urinary tract disorders were observed. With a median follow-up of 12 weeks (range: 3-44), 11 patients were completely continent (50%), 5 patients were significantly improved (22.7%) and 6 patients were considered to be failures (27.3%), 3 of whom had previously received external beam radiotherapy. Conclusion: The INVANCE(R) process appears to be a simple and effective option for the treatment of grade 1 and 2 postoperative male stress urinary incontinence.