AdVance XP, Sling Implant

Clinical history:

• 71 years old
• High Blood Pressure
• Type 2 diabetes
• Laparoscopic radical prostatectomy (August 2017)
• Adenocarcinoma Gleason 3+3, pT2c
• 1-year follow-up: PSA 0 ng/ml

Other history:

• Established stress urinary incontinence (> 1 year after radical prostatectomy)
• Cystoscopy: rule out bladder neck contracture
• Urodynamics: stress urinary incontinence. rule out bladder outlet obstruction and overactive detrusor
• 24 hours pad test: 13 g

Technique description:

• AdVance XP ® trans-obturator male slings corrects the weakness of the posterior support
• Its mechanism of action is based on the relocation of the external urethral sphincter within the pelvis

Steps in the procedure

• 1. The bulbo-spongiosus muscle is incised along its longitudinal axis
• 2. A helical rounded tip needle is introduced along the lateral edge of the pubic ramus, pointing towards and coming out at the uppermost corner between the urethral bulb and the inferior pubic ramus
• 3. The edge of the proximal flap of the sling should be located at the origin of the central tendon previously marked

Learning points:

• We must cut the central tendon short to avoid the slippage of the sling
• Reception of needle in the upper angle (ischiopubic branch and bulbous urethra)
• The tape is tunneled to avoid migration