To determine long-term durability of the AdVance sling for post-prostatectomy incontinence (PPI) and impact of prior radiotherapy and storage dysfunction.

Eighty men undergoing AdVance sling for PPI during 2008-2013 were reviewed at different time-points post-operatively (3 years and 9 years). Pre-op urodynamics, pre and post-op pad usage, prior radiotherapy, PGI-I scores and decision regret were recorded.

Mean follow-up was 111 months (range 81-136). 8 men died between mid-term and long-term follow-up. Twelve men had radiotherapy pre-op, 10 had detrusor overactivity (DO), and 20 reduced compliance. Pre-op mean 24-hr pad weight was 264 g and mean pads-per-day (PPD) 2.49. In the early post-op period (3-6 months) mean PPD was 0.41, at mid-term follow-up (3 years) 0.58 and at long-term follow-up (9 years) 1.04. At mid-term follow-up (3 years) mean PGI-I score was 1.84 and at long-term follow-up (9 years) 1.71. 
When asked about their main health concern at long-term follow-up (9 years), 1 in 5 men cited their incontinence as their main health concern. Five men went on to have an artificial urinary sphincter (AUS) inserted one man went on to to have a second transobturator sling procedure and one man a bulking agent procedure. Of the seven men who had a subsequent incontinence procedure, two had a history of radiotherapy or DO. When the whole cohort was asked about decision regret, 1 in 7  men regretted having the sling put in:  A third of of these men were those who had a subsequent incontinence procedure. 
At mid-term follow-up, PGI-I score for men without radiotherapy or DO was 1.42 ("much better") and in the long-term 1.57. With radiotherapy or DO PGI-I score at mid-term was 4 ("no difference") and at long-term follow-up, was 2.6 In calculating the long-term PGI-I score, the men who had repeat incontinence procedures were excluded from the calculation.
At mid-term follow-up, PPD for men without radiotherapy or DO was 0.27, and in the long-term 0.77: this remains to be better than their pre-op PPD usage. With radiotherapy or DO, at mid-term follow-up, PPD usage was 2.2 and in the long-term 1.8. In calculating the long-term PPD usage, the men who had repeat incontinence procedures were excluded from the calculation.

The AdVance sling provides long-term improvement in men with PPI and remains a very valid option of management in the well-selected individual. Men with radiotherapy or DO have significantly poorer outcomes. Pre-op urodynamics in men with radiotherapy and/or overactive bladder may be important when considering men for AdVance sling.

The AdVance sling provides long-term improvement in men with PPI and remains a very valid option of management in the well-selected individual. .

Habashy D, Losco G, Tse V, Collins R, Chan L. Mid-term outcomes of a male retro-urethral, transobturator synthetic sling for treatment of post-prostatectomy incontinence: Impact of radiotherapy and storage dysfunction. Neurourol Urodyn. 2017 Apr;36(4):1147-1150. doi: 10.1002/nau.23078. Epub 2016 Jul 26. PMID: 27460195.