Overview
The AdVance XP is a synthetic sling that is placed with surgery to help men with stress urinary incontinence.
The male sling is used to treat urinary incontinence (leakage on activity such as exertion, movement, coughing, laughing or sneezing) after prostate removal surgery
Approximately 70% of men are satisfied with the outcome of their surgery
There are different types of male sling available on the market with different mechanisms of action
Most male slings are synthetic and use “mesh”. At the present time, the use of “mesh” in women for stress incontinence has been controversial because of some side effects
If removal of mesh in men becomes necessary, it is a complex procedure that may not be technically possible
Details
Indications
The AdVance XP male transobturator sling is a synthetic sling designed to help men with stress urinary incontinence. Stress urinary incontinence in men is usually seen after surgery for prostate cancer (radical prostatectomy), but can also be seen after surgery for benign prostate disease (TURP, HoLEP, Greenlight PVP etc.) or in patients with neurological injuries (spinal cord injuries). Read our guide about the causes of male stress urinary incontinence here.
An AdVance XP male sling is best for men who lead a minor to moderate amount of urine. This may be using 1-2 continence pads per day. Results are not as good if you have had radiotherapy to your prostate or pelvis.
The sling does not treat urge urinary incontinence, which is leakage due to bladder spasms. This leakage can also be common after men have had surgery for prostate cancer or benign prostate disease. Some patients will have both types of leakage and will need multiple treatments.
Male Sling vs. Artificial Sphincter – which one is better for you?
Read our article that compares and contrasts the two main surgical treatments for stress urinary incontinence in men.
Alternatives
There are other effective treatment options for stress urinary incontinence in men. Speak to your multidisciplinary team (prostate cancer nurse specialist, physiotherapist, continence nurse and urologist) about what would be best for you.
Non-surgical Options
- Continence wear
- continence pads
- continence underwear
- penile clamps
- external sheaths
- Pelvic floor muscle strengthening exercises
Surgical Options
- Other types of male slings (ATOMS, Virtue)
- Urethral bulking injections
- Artificial urinary sphincters (Boston Scientific AMS, Rigicon)
- Permanent bladder catheters (urethral or suprapubic)
- Urinary diversion (ileal conduit)
For men with stress urinary incontinence after a radical prostatectomy, the non-surgical options (pelvic floor muscle exercises and continence wear) are the best treatments in the first year following the radical prostatectomy. During this time, there is often ongoing improvement in the amount of leakage. After 12 months, it is unlikely there will be further significant improvement in stress urinary incontinence, and surgical treatments could be considered.
Before the procedure
Tests: Urodynamics, Flexible cystoscopy, Urine MCS
May need preadmission medical assessment
Stop anticoagulation
The procedure
The procedure is performed under a general anaesthetic (with you asleep). We give you antibiotics immediately before the procedure. Your legs are placed into stirrups, and your skin is cleaned with antiseptic. A flexible cystoscopy is often performed at the start of the procedure to ensure no issue with the urethra, bladder or junction between the two. We then put a catheter into your bladder through your urethra, which is kept in place throughout the procedure.
A small incision (5 – 10cm) is made on your perineum (the skin between the back of your scrotum and your anus). Two small incisions (0.5 cm) are made in your groin on both sides. The urethra is free up from the surrounding tissue. The sling is placed under the urethra to support it and secured to the urethra with stitches. The arms of the sling come out of the small incisions in each groin. The sling is then tightened and locked into place.
We close your skin with dissolvable stitches, which normally disappear within two to three weeks. Dressings are placed over the three incisions.
You can expect to stay in the hospital for two nights. The catheter is removed after the second night, and we make sure you can pass urine before you go home. If you can’t pass urine (<10% of patients), you might need to go home with a temporary catheter for around 1 week while your swelling settles.