1. Modification of the InVance Male Sling Procedure: Treatment of Stress Incontinence after Radical
Prostatectomy
Richard Cotran, University of Rochester, Marc Bienz, University of Montreal, Ilija Aleksic, SUNY Upstate Medical University, Vladimir
Mouraviev, Bashar Omarbasha Associated Medical Professionals of NY, PLLC
Abstract Objective
Methods
Results
Results
Conclusion
Introduction
.
INTRODUCTION
Incontinence is not uncommon after radical prostatectomy due to damage to the external urethral
sphincter. In January 2009, the InVance male sling procedure underwent two modifications; releasing
the central tendon and a relocation of the screws more medially on each pubic rami. The aim of this
study is to determine how these modifications influence the outcome of surgery.
METHODS
Patients were classified by date of surgery. Group A (n=25) had the unmodified sling procedure and
group B (n=34) were operated with the modified sling. Post-operative outcomes were compared
between groups using the International Continence Society Male Short Form (ICS-SF) and the Patient
Global Impression of Improvement Scale (PGI-I), using a grading system where low scores indicate
more successful outcomes. The Patient Satisfaction Scale (PSS) was used to determine patient
satisfaction.
RESULTS
Preoperatively, 57 (97%) patients used ≥ 2 pads daily. After surgery 13 (52%) of patients in group A
used ≤1 pad compared to 30 (88%) for group B (p<0.01). The ICS incontinence section showed that a
higher proportion (p<0.05) of group B (79%) had a low score (<10/24) compared to group A (60%).
Results of the PGI-I scale show that group B (68%) had a higher proportion (p<0.05) of positive
response compared to group A (36%). The PSS showed higher satisfaction (p<0.05) of patients in
group B (76%) than in group A (44%).
CONCLUSION
The modified sling procedure suggests more promising results. In fact, there was a significant reduction
in incontinence and improvement in the patients’ satisfaction. In conclusion, the modified sling
procedure improved continence with few risks and no new adverse effects.
Male stress urinary incontinence (SUI) is a common complication after prostate
surgery due to urethral sphincter dysfunction. Low quality of life is common in men
who have problems with SUI. They are generally embarrassed and depressed, and
may experience social isolation. The male sling procedure was developed to help
correct male stress urinary incontinence. The procedure is proving that this option is
most satisfactory for men with mild-to-moderate urinary incontinence (2 to 3 pads per
day or less). One of the distinct advantages of the male sling is that it only requires a
small incision between scrotum base and the anus and involves a fairly short recovery
period.
This study was designed to determine how InVance male sling procedure modifications affect the outcome of surgery
compared to the standard procedure.
We conducted a chart review of our patients and were able to identify 59 patients who had the sling operation. In January
2009, we made two modifications to the InVance male sling procedure: releasing the central tendon and a relocation of the
screws more medially on each pubic rami, in order to restore pelvic floor anatomy to restore continence. Patients were
classified by date of surgery into 2 groups. Group A (n=25) had the original sling procedure while group B (n=34)
underwent the modified procedure.
Post-operative outcomes were compared between groups using the International Continence Society Male Short Form (ICS-
SF) and the Patient Global Impression of Improvement Scale (PGI-I), using a grading system where low scores indicate
better results. The Patient Satisfaction Scale (PSS) was also used to score patient satisfaction.
 The modified sling procedure suggests more promising outcomes.
 There was a significant reduction in incontinence and improvement in the patients’
satisfaction.
 The modified sling procedure improved continence with few risks and no new
adverse effects.
Fig1. Modified InVance technique Fig.3. Final sling placement
Fig. 2. Endoscopic control of sufficient sling suspension to tighten a sphicter
Results Group A
(unmodified)
Group B (modified) p-value
Post-operatively used
<1 pad/day
13 (52%) 30 (88%) p<0.01
ICS-I score <10/24 15 (60%) 27 (79%) p<0.05
PGI-I positive
response
17 (68%) 12 (36%) p<0.05
PSS positive response 11 (44%) 26 (76%) p<0.05