AdVance XP - Sling for male stress incontinence

Authors: Geraldo Macedo1, Gerard Henry2#

Key words: AdVance XP, male urinary incontinence, male sling

The video outlines the technique for placement of AdVance XPÒ (Boston Scientific, formerly American Medical Systems) retrourethral male sling. The Male stress urinary incontinence is a complication of prostate cancer treatment. The surgical treatment is indicated after conservative options have failed (Bauer, Grabbert et al. 2017). The retrourethral male sling (AdVance Ò sling)  has been used since 2007 (Rehder and Gozzi 2007). Is indicated to patients with mild to moderate stress urinary incontinence, preferably without prior radiation therapy or nocturnal continence. Some experts consider the ability to stop and hold urine mid-stream with a full bladder an important selection criterion. Complications are urinary retention, continued urinary incontinence, de novo urinary urgency and rarely erosion.  AdVance XPÒ was launched in 2010, and in 2019 it was introduced to the US and Brazilian markets. The surgical technique for implantation is very similar to the advance sling, with some minor but important differences. The chevron anchors help prevent the sling from loosening once tensioned and should not be pulled as tightly as in the AdVance sling. Due to the chevrons, some doctors no longer tunnel the tails of the sling. Foley catheter should be kept overnight. Urinary retention is uncommon, but if that happens, replace Foley, as most patients will improve with time. This video demonstrates how the authors perform the implantation of the AdVance XP male sling, and give tips and tricks for optimum results.

Acknowledgements: None

Disclosures: Henry Gerard: Boston Scientific, Coloplast Corporation, Microgen Corporation, Superior Vas

References:

  1. Bauer, R. M., M. T. Grabbert, B. Klehr, P. Gebhartl, C. Gozzi, R. Homberg, F. May, P. Rehder, C. G. Stief and A. Kretschmer (2017). "36-month data for the AdVance XP((R)) male sling: results of a prospective multicentre study." BJU Int 119(4): 626-630.

  2. Rehder, P. and C. Gozzi (2007). "Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy." Eur Urol 52(3): 860-866.