Implantation of the InVance® male sling system is a minimally invasive procedure that typically takes around 30-45 minutes. Following is a brief summary of the InVance surgical procedure.

Caution: This information is for educational purposes only. Refer to the surgical step procedure and videos for more detailed instructions on this surgical procedure.

Step 1
Place the patient in a modified lithotomy position. Insert a 14 Fr. Foley catheter into the bladder to aid in urethral palpation. Palpate the symphysis pubis to determine the incision site. Make a 3-4 cm midline perineal incision.

Step 2
Carry out scissor dissection laterally to expose the medial aspect of the descending pubic rami on both sides. Expose the bone where the screws are to be placed. Preserve the bulbospongiosus.

Step 3
Using the InVance Inserter, place three AMS Screws with polypropylene sutures in each rami. Place the proximal pair as high on the descending ramus as possible, just beneath the pubic symphysis. Space the subsequent pairs 1 cm apart.

Step 4
Grasping the InVance Inserter, press the screw firmly to the bone. Activate the Inserter until the motor changes pitch, indicating that the screw is firmly seated. Pull on the suture to ensure good capture.

Step 5
After all screws are placed, cut the ends of each suture. The sling material can be trimmed to ensure appropriate fit on the pubic bone. On one side, pass sutures through the sling material with the aid of an 18 gauge needle. Firmly tie the sling to the bone on that side.

Step 6
Using a right angle clamp, pull the sling across the urethra to approximate its secured position. Confirm tension using either a Cough Test (if patient is awake) or Retrograde Perfusion Pressure (RPP) Test. Mark the sling material with a sterile marker to facilitate suture placement.

Step 7
Cough Test—(Only if patient is awake) Fill the bladder and ask the patient to give a strong cough to determine appropriate sling tension.
RPP Test—Pull back the catheter into the distal penile urethra and fill the balloon with 1cc of saline. Connect the catheter to a saline infusion bag via sterile tubing. Elevate the bag until infusion begins. Record the retrograde leak point pressure in cm of water from the level of the symphysis to the top of the fluid column (top of water level in saline bag).

Step 8
Pass the remaining sutures through the sling material. Tie the sling down completely, beginning with the most anterior screw. Confirm appropriate sling tension and trim all sutures. Close in a multi-layer closure.

Invance 8-Step Procedure Guide