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What is the place of the Artificial Urinary Sphincter in 2012? Introduction There are an increasing array of surgical options for the treatment of post-prostatectomy incontinence, including bulking agents, peri- urethral balloons and a variety of male sub-urethral slings. We have reviewed the results of men treated with AdVance slings or artificial urinary sphincters (AUS) in order to better define the indications for these respective procedures and predict optimal clinical outcomes. Conclusions AdVance slings offer a safe, effective treatment of mild-mod post- prostatectomy continence with the vast majority of men remaining improved in the medium term, although the pad-free rate declines over time, particularly in irradiated men AUS remains the most effective treatment for severe post- prostatectomy stress incontinence, with high satisfaction rates even though most men still use a pad when validated questionnaires used Urethral strictures are more common after radiotherapy and often cannot be stabilised, however can still be maintained through an AUS or AdVance sling Results outcomes Peri-operative complications AdVance sling - 14 (25.9%) temporary urinary retention, 2 (3.7%) lasting more than two weeks and requiring cystoscopy/dilatation - 2 (3.7%) transient hip pain resolving spontaneously - No pelvic haematoma or sling infection AUS (Approach 11 [23.4%] perineal, 36 [76.6%] penoscrotal) - 1 (2.1%) infection requiring explantation - 1 (2.1%) scrotal haematoma - 1 (2.1%) urethral injury - 1 (2.1%) pulmonary embolism Functional outcomes AdVance sling 50 men (92.6%) immediately pad-free Mean F/U 9.7 mths (1-36) At follow-up - 40/52 (76.9%) men with mild-mod incontinence pad- free vs 0/2 men with severe Incontinence Of those men with prior RT 4/7 (57.1%) pad-free Of those men with minimum 12 mth F/U (mean 21.6, 12-36mth) - mild-mod incontinence (n=14): All improved, 9 (64%) pad-free, - severe incontinence (n=2): 1 improved, 1 failed and had AUS Functional outcomes Artificial urinary sphincter Mean F/U 23 months (3-60) AUS revision rate 17% - Early: 4 (8.5%) tandem cuff for persisting incontinence - Late: 4 (8.5%), 1 erosion, 1 mechanical failure, 2 cuff atrophy Methods Peri-operative data of consecutive patients operated on for post- prostatectomy incontinence by a single surgeon were recorded on a prospective database Short and medium-term outcomes were reviewed Patients who had undergone insertion of an artificial urinary sphincter were asked to complete a questionnaire amalgamated from 4 validated existing instruments: the international Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Post- Operative Global Impression of Improvement (PGI-I), Incontinence Impact Questionnaire- Short Form (IIQ-SF) and Urogenital Distress index (UDI-SF) Level of incontinence was defined as: Mild (1 pad/day or 3 pads/day or >400ml pad weight) Aim To evaluate peri-operative and functional outcomes of men undergoing surgery for post-prostatectomy incontinence To assess short-medium term results of the artificial urinary sphincter and AdVance suburethral sling and their relative roles in the management of post-prostatectomy incontinence Figure 1. Continence outcomes for all men at mean F/U 9.7mth after AdVance sling. 74% pad free, 22% requiring a pad but improved, 4% recurrent incontinence Figure 2. Continence outcomes at mean 23 mth after I/O AUS Dr Daniel Moon and Ms Kay Talbot Australian Urology Associates, Melbourne, Victoria Poster presentation sponsor No. 057 Results pre-operative 101 men underwent surgery between 2007-2011; 47 underwent insertion of AUS and 54 an AdVance sling The AdVance sling was generally only offered to patients with mild- mod incontinence, only 2 being inserted for patients with more significant leakage Of patients with severe incontinence undergoing AUS: - Mode of RP: 53% open, 45% robotic, 2% lap - Prior radiotherapy was predictive of co-existing stricture present in 53.8% of irradiated men vs 8.8% who had undergone surgery alone AdVance sling (n=54) Age67 (54-84) Prior bulking agent 5 (9.3%) Prior RT7 (12.9%) Incontinence: Mild26 (48.1%) Moderate26 (48.1%) Severe2 (3.7%) AUS (n=47) Age68 (58-85) Prior surgery Macroplastiqu e 18 (15 men) 9 (19.1%) ProACT2 (4.3%)* Sling3 (6.4%) AUS5 (10.6%)# Prior RT13 (27.7 %) Stricture10 (21.3%) * 1 eroded # 2 eroded Table 1. Pre-operative patient parameters Figure 3. Quality of life measures post AUS 26%26% 67%67% 2%2% 5%5%