title: Management of recurrent post-prostatectomy incontinence after previous failed retrourethral male slings.
abstract: OBJECTIVE
  Our objective was to establish the feasibility of combining 2 minimally invasive procedures in patients with failed primary treatment (male sling) in post-prostatectomy incontinence (PPI) patients.
  
  
  METHODS
  From January 2007 to July 2008, 40 men with PPI were implanted with a suburethral tape (2 patients with Seratim, 3 with I-Stop and 35 with Advance). The median preoperative pad count was 4 (range 2-10). Prior to sling placement, 6 patients had undergone ProACT implantation. Of these, 4 patients required explantation due to balloon migration and 2 patients had their balloons kept in situ, with the balloons deflated.
  
  
  RESULTS
  Twenty-five patients were socially continent at this time. Fifteen patients (37.5%) did not improve or their improvement was not significant. These patients had a preoperative pad count between 7 and 10. Two of these patients had prostate adjustable continence therapy (ProACT) systems still in place. By gradually filling the balloons to 3 mL, both of these patients achieved complete continence, which was maintained at a mean follow-up of 8.5 months. Three patients with prior pelvic irradiation received an artificial urinary sphincter and achieved continence at mean follow-up of 8.3 months. The remaining 10 patients received a ProACT system in addition to the already implanted sling. After appropriate healing and filling of the balloons (average balloon volume 5 mL), all 10 patients reached complete continence; they were pad-free at a mean follow-up of 6 months (range 3-9).
  
  
  CONCLUSIONS
  The combination of ProACT and a suburethral tape was demonstrated to be a possible treatment option in recurrent or persistent PPI.
authors.affiliation: Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Amr
authors.initials: A
authors.lastname: Al-Najar
authors.forename: Sascha
authors.initials: S
authors.lastname: Kaufmann
authors.forename: Soenke
authors.initials: S
authors.lastname: Boy
authors.forename: Carsten Maik
authors.initials: CM
authors.lastname: Naumann
authors.forename: Peter-Klaus
authors.initials: PK
authors.lastname: Jünemann
authors.forename: Christof
authors.initials: C
authors.lastname: Van Der Horst