Advance Sling vs. Invance Sling -

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tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 3/19/2010 9:17 AM (GMT -6)   
As I continue to work on my incontinence, I am looking into alternative solutions to the problem at the end of my seasonal work (October - 11 month anniversary after surgery). My job involves heavy lifting and would not be able to do my work if I had a sling installed in the summer.

At four months out, I am down to 1 pad a night and 2-3 pads during the day - most of the leakage is from stress incontinence - getting up from chair or car seat, lifting. I am able to control it until I get to the bathroom - but unable to stop/start the flow on command - once it starts - the flood waters just go !

Have looked over the two styles of slings and wonder who has a better ratio of success ?

-the doctor at the recent lecture says he has a very high success rate 90% for his 1000+ patients ( he has been doing this operation since 1996 when the sling came out) - but when I search on the web for other studies - cornell and another site - stated only 55% success rate with 75% success rate ( including those with better control than before).

any of the sling guys have any feedback on this?
I am not jumping the gun - just doing research - have read some earlier topic postings here and wondering if anyone has changed their mind on the procedure over time.

-thanks
BRONSON

P.S. am aware of tallguy's coloplast sling postings - and found just now - drewboy's start of his journey - all the best -
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: 3-5 pads/1-2 clothes changes/day- finally seeing improvement - March 3, 2010 - week 14 after surgery -
location: Peteborough, Ontario, Canada
Post Surgery-PSA: to be announced - April 8, 2010
............

Post Edited (tatt2man) : 3/19/2010 8:21:33 AM (GMT-6)


Utrecht
New Member


Date Joined Nov 2009
Total Posts : 6
   Posted 3/19/2010 4:52 PM (GMT -6)   
Dear Bronson,

I work in urology and would be surprised if any urologist anywhere in the world has done 1000 InVance slings (and certainly not in Canada). This product never became very popular because of several reasons. There was a significant amount of post-op pain (perineal) that lasted for long periods of time (probably a result of the screws being drilled in the bone), there is a certain incidence of screws becoming dislodged, requiring re-operation and thirdly there is a chance(though slight) of osteomyelitis (infection in the bone). If this happens, the infected bone needs to be removed. (a major operation).

I would consider other male slings or the ProACT device, which is not available in the US, but is available in Canada.

best regards

Ben

bigxbadxjohn
New Member


Date Joined Nov 2009
Total Posts : 2
   Posted 3/19/2010 7:30 PM (GMT -6)   
Dear Bronson,

I am probably one of very few individuals that has had two different slings implanted. Prior to my first surgery, I had required 1-2 pads per day since my prostatectomy ten years ago.

Last July I consented to having an AdVance sling or AdVance type sling implanted into my body. Prior to surgery, my urologist told me this sling had been in usage for three years with an impressive 85% success rate. I was told that I was an excellent candidate for this surgery.

For reasons unknown to me, to my horror and without my consent, the surgeon switched slings on me, during surgery, and implanted a Virtue sling by Coloplast. From the first day, my incontinence increased from 1-2 pads per day pre-surgery to 4-5 pads per day. This was bad but pain was a MUCH bigger problem. The pain was continuous and absolutely intolerable.

My suffering continued non-stop until I was finally able to have the Virtue sling removed five months after being implanted. This required a 3 1/2 hours of major surgery by a specialist at The Cleveland Clinic, Cleveland, Ohio.

Near the conclusion of this second surgery I was implanted with the AdVance sling that I had consented to five months earlier. It has been fantastic! I have not spilled one drop since it was implanted. The pain is diminishing daily I can cough, sneeze, blow my nose and do jumping jacks without hesitation or any leakage. For the first time in ten years I feel naturally dry.

I can not say at this time if my horrible experience was caused by the Virtue sling, by mistakes made my the surgeon or a combination of the aforementioned. I can say I had no pelvic pain or discomfort prior to my surgery last July.

You can read more about my sling ordeal if you look for bigxbadxjohn postings probably starting about August 2009.

I highly recommend doing a lot of research prior to committing to any surgical procedure. From my experience, a very favorable outcome is possible.

Best wishes,

John

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 3/19/2010 7:44 PM (GMT -6)   
Ben and John
- thank you for your responses - I may have misheard 1000 slings installed instead of 1000 patients being treated for incontinence.
I will look up your postings John. That is one of the best benefits of HW is seeing / hearing from men who have already gone the path that is all too new - and at times, scary and confusing.

Dr. Michael Greenspan was the lecturer at the prostate cancer support group. Dr. Greenspan is a professor of prosthetic surgery at McMaster Institute of Urology in Hamilton.
His talk on zero tolerance (radical prostatectomy incontinence) was informative and fun and updated us on the latest treatment options available for this problem.
He also has an associate in tow with pamphlets from AMS with different products and services available.

slowly improving hugs,
BRONSON
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: 3-5 pads/1-2 clothes changes/day- finally seeing improvement - March 3, 2010 - week 14 after surgery -
location: Peteborough, Ontario, Canada
Post Surgery-PSA: to be announced - April 8, 2010
............


tallguy
Regular Member


Date Joined Oct 2009
Total Posts : 419
   Posted 3/20/2010 1:45 PM (GMT -6)   
Be careful about any "success" rates you hear about slings. Based on what I have read success mean different things to different people. Totallly dry is usually a very small % with most studies. One pad a day may be in  the definition of success of some studies. Or, they may just have the patient define their degree of  success with their outcome which may be one or two pads per day.
I had Virtue sling surgery six weeks ago. I improved from 4-5  pads per day to 2-3 pads per day..some days 1-2 pads. This is an improvement but would not be defined as "success" by most patients standards. See Tallguys journey with coloplast sling surgery on this forum to see my story. Another guy on the forum "rapids" had similar conditions to me. After learning of his success.  had the same surgery and used the same Dr. at NYU. He is basically dry. He recently did a post on Virtue sling.
I considered the InVance sling since that was primarily what my Uro was doing but decided against because of the bone anchoring and residual pain some people seem to experience. AMS literature positions AdVance for mild incontinence and InVance for moderate incontinence and AUS sphincter for sever incontinence.
Based on what I learned on this forum InVance appears to be outdated and most Drs have moved to AdVance. Virtue by Coloplast is so new there is very little information available and no clinical trials have yet been published. In theory it should provide a stronger fix. But, there is no data to support that yet.
 
64  year old male in excellent physical condition.
PSA jumped  3 to 8 in one year
pt2b NO Mx with a Gleason score 3+3=6.
DaVinci RP,  7/23/08. Tumor type: Acinar
size 5.5 cm x 5.7 cm weight: 77 gm.
Largest tumor nodule: 1.3 cm. All margins negative.
Incontinence & ED. Dry nights , no control during day.
Imipramin and detrol, Phy ther. and kegals no help.
FUDS and cystourethroscopy testing 10/09.
24 hr pad wt. 219gm. AUA sympton index 13/35=moderate
Incontinence symp. index severeity score=22
Rec. for sling surgery. Dr. does mostly InVance.
Researched and decided on either AdVance or Virtue.
Virtue sling surgery 2/3/10 NYU med center by Dr. Victor Nitti
Only partial improvement to 2-3 pads per day. Back on imipramin and may try collegen injections.
 


tallguy
Regular Member


Date Joined Oct 2009
Total Posts : 419
   Posted 3/20/2010 1:47 PM (GMT -6)   
tatt2man
Sorry, I just noticed that you already saw my journey posts. sorry for the duplication
64  year old male in excellent physical condition.
PSA jumped  3 to 8 in one year
pt2b NO Mx with a Gleason score 3+3=6.
DaVinci RP,  7/23/08. Tumor type: Acinar
size 5.5 cm x 5.7 cm weight: 77 gm.
Largest tumor nodule: 1.3 cm. All margins negative.
Incontinence & ED. Dry nights , no control during day.
Imipramin and detrol, Phy ther. and kegals no help.
FUDS and cystourethroscopy testing 10/09.
24 hr pad wt. 219gm. AUA sympton index 13/35=moderate
Incontinence symp. index severeity score=22
Rec. for sling surgery. Dr. does mostly InVance.
Researched and decided on either AdVance or Virtue.
Virtue sling surgery 2/3/10 NYU med center by Dr. Victor Nitti
Only partial improvement to 2-3 pads per day. Back on imipramin and may try collegen injections.
 


tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 3/20/2010 2:05 PM (GMT -6)   
no problem tallguy - thank you for caring and sharing -
hugs
BRONSON
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: 3-5 pads/1-2 clothes changes/day- finally seeing improvement - March 3, 2010 - week 14 after surgery -
location: Peteborough, Ontario, Canada
Post Surgery-PSA: to be announced - April 8, 2010
............


tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 3/21/2010 1:01 PM (GMT -6)   
I wrote to the doctor and got the following message -
........
I have done slings but because of budgetary issues the only prosthetics I am now doing are penile implants. We have another surgeon here in Hamilton who is doing slings
Hundreds of Advance slings have been done with excellent results re complete dryness. Followup with many of these is now greater than 5 years
.........
Will look into it in October if necessary - still working on my kegels and positive thoughts ...
all the best.
BRONSON
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: 3-5 pads/1-2 clothes changes/day- finally seeing improvement - March 3, 2010 - week 14 after surgery -
location: Peteborough, Ontario, Canada
Post Surgery-PSA: to be announced - April 8, 2010
............


Utrecht
New Member


Date Joined Nov 2009
Total Posts : 6
   Posted 3/23/2010 8:57 AM (GMT -6)   
Bronson,

I notice that the doc claimed greater than 5 year follow-up with the Advance sling. The product was launched in August 2006 (without any clinical study data). There are no studies that have 5 year data on this device. One of the inventors had published data with some patients gong back to around 2006, but the majority are more recent. It appears that the very positive initial results are not being maintained and more recent articles report lower cure and improve rates as well as more complications.

Best regards

Ben

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 3/23/2010 11:34 AM (GMT -6)   
thank you Ben - all feedback is appreciated..
. that is what concerned me when the Cornell study ( of only 36 men) had a success rate of 55% men ..
here is some more info... with appropriate listing of original source
hugs
BRONSON

-from AMS website -www.amsadvance.com/about.htm
"The AdVance™ Male Sling System was created by two urologists practicing in Innsbruck Austria, Drs. Christian Gozzi and Peter Rehder... teamed with AMS in 2004."

-from Elsevier site -[rurl]http://www.escardiocontent.org/periodicals/yeupc/article/S0302-2838%2809%2900932-4/abstract
"Conclusions

Placement of a transobturator sling is a safe and effective procedure, giving durable results after >1 yr of follow-up. Further evaluation and high-quality controlled, randomized studies are needed to assess long-term efficacy and precise indications of this procedure for post–prostatic-surgery SUI management.
Take Home Message

In management of mild to moderate stress urinary incontinence after prostatic surgery, the transobturator male sling is a safe and feasible procedure. It is effective, with a durable success rate of 80% after >1 yr of follow-up."
.......................
...........
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: 3-5 pads/1-2 clothes changes/day- finally seeing improvement - March 3, 2010 - week 14 after surgery -
location: Peteborough, Ontario, Canada
Post Surgery-PSA: to be announced - April 8, 2010
............


Wigs
Regular Member


Date Joined Mar 2009
Total Posts : 89
   Posted 3/29/2010 8:39 AM (GMT -6)   
tatt2man, have you had any discussions with your doctor concerning the AUS implant? That's another alternative I'd strongly suggest.

Wigs
Diagnosed @ age 47 - September 1997
PSA 5 / Gleason 3+3
Seed Implant - January 1998 @ Trident Hospital, SC
PSA 2.4 - July 2007
PSA 2.7 - July 2008
PSA 3.0 - November 2008
Diagnosed @ age 57 - December 2007
Gleason 4+3
Salvage Prostatectomy & Colostomy - March 2008 @ MSKCC, NY
Urethral-Rectal Fistula Repair - August 2008 @   Cleveland Clinic, OH
PSA < .03 - Aug 2008
Colostomy Reversal - January 2009 @ Cleveland Clinic
PSA < .03 - Jan 2009
AUS implant - May 2009 @ Cleveland Clinic
PSA < .03 - May 2009
AUS activated - July 2009
PSA < .03 - July 2009
Penile Implant - December 2009 @ Cleveland Clinic
PSA < .03 - December 2009
Penile Implant activated - February 2010
 
 


tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 3/29/2010 9:51 AM (GMT -6)   
Wigs - it is my understanding that the AUS implant is for heavy leakers with little or no control - ie. 7 pads or more a day - there have been other incontinence topics on number of pads, volume and pad weight - that would be discussed with an urologist.

I am only a 1 pad at night - 2-3 pad a day - most leaking due to stress incontinence - ie. getting in and out of the car ... working in my woodshop for my artwork - vibrations from router / sander / circular saw -
I will be waiting until end of season and see how I am then. Right now it is a bother but not severe ( in my outlook right now)

Thank you very much for your comments and concern

- how is your AUS implant working for you? - and your penile implant - and other surgeries - ? - you could be the poster boy for the Bionic Mr. Happy Brigade - now that would be an interesting 3-D movie !!

HuGs
BRONSON
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: 3-5 pads/1-2 clothes changes/day- finally seeing improvement - March 3, 2010 - week 14 after surgery -
location: Peteborough, Ontario, Canada
Post Surgery-PSA: to be announced - April 8, 2010
............


Wigs
Regular Member


Date Joined Mar 2009
Total Posts : 89
   Posted 3/29/2010 1:55 PM (GMT -6)   
tatt2man,

I am doing well and that is why I mentioned the AUS. Reading your signature, I wouldn't say that anyone changing clothes on a daily basis would be considered anything but a heavy leaker. Best of luck to you.

Wigs

P.S.
(As my son said after hiking the Appalachian Trail, "Dad, your trail name would be Robo-Cock.")
Diagnosed @ age 47 - September 1997
PSA 5 / Gleason 3+3
Seed Implant - January 1998 @ Trident Hospital, SC
PSA 2.4 - July 2007
PSA 2.7 - July 2008
PSA 3.0 - November 2008
Diagnosed @ age 57 - December 2007
Gleason 4+3
Salvage Prostatectomy & Colostomy - March 2008 @ MSKCC, NY
Suprapubic cathether installed - July 2008 @ Cleveland Clinic, OH
Urethral-Rectal Fistula Repair - August 2008 @   Cleveland Clinic, OH
PSA < .03 - Aug 2008
Penile catheter removed October 2008
Suprapubic catheter removed December 2008
Colostomy Reversal - January 2009 @ Cleveland Clinic
Urethral stricture removed - January 2009 @ Cleveland Clinic
(Total incontinence - 4 diapers & 6 - 8 pads per 24 hour period)
PSA < .03 - Jan 2009
AUS implant - May 2009 @ Cleveland Clinic
PSA < .03 - May 2009
AUS activated - July 2009
(Wearing a light pad daily.)
PSA < .03 - July 2009
Penile Implant - December 2009 @ Cleveland Clinic
PSA < .03 - December 2009
Penile Implant activated - February 2010
 
 


tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 3/29/2010 2:30 PM (GMT -6)   
WIGS -
due to the shortened nature of mr. happy - I sometimes pee/ leak sideways - have beergut so undershorts and pants ride low - will update signature
- thanks
- BRONSON

p.s. signature showed improvement in march - will update it for today - march 29.
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: Feb 2010- 3-5 pads/1-2 clothes changes/day- March 3, 2010 - week 14 after surgery -finally seeing improvement - March 29- incontinence better - 1-2 pads a day - one pad at night
location: Peteborough, Ontario, Canada
Post Surgery-PSA: to be announced - April 8, 2010
............

Post Edited (tatt2man) : 3/29/2010 1:36:14 PM (GMT-6)

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