title: Evaluation of salvage male transobturator sling placement following recurrent stress urinary incontinence after failed transobturator sling.
abstract: OBJECTIVE
  To evaluate the outcome of patients treated with a salvage AdVance male sling after a failed primary transobturator sling placement.
  
  
  METHODS
  Retrospective review of patients treated at our center with a primary and subsequent salvage AdVance sling. Success was defined as a dry safety pad or no pads (cured), or >50% improvement in pads used per day and patient satisfaction (improved). Early primary sling failures (<6 months) were compared with late (≥6 months) failures with regard to continence outcomes.
  
  
  RESULTS
  We identified 18 patients who underwent a salvage AdVance sling placement at our institution. Overall success was 72% at 6 months postoperatively and 56% at a mean follow-up of 17.5 months, including 50% and 39% of patients who were dry at those same time periods. Patients failing late after their primary sling (n = 8) enjoyed improved outcomes with salvage sling placement compared with patients who failed early (n = 10) after the primary sling. At 6 months, more patients in the late primary failure group were cured (75% vs. 30%; P = .031). These improved cure rates remained significant through final follow-up with cure rates of 63% and 20%, respectively (P = .041).
  
  
  CONCLUSIONS
  Salvage AdVance male sling is a viable treatment option after a failed primary sling procedure, especially in patients who demonstrated a prolonged efficacy period before primary sling failure.
authors.affiliation: Department of Urology, Eastern Virginia Medical School, Norfolk, VA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Martinez
authors.affiliation: Department of Urology, Eastern Virginia Medical School, Norfolk, VA. Electronic address: jmzuckerman@gmail.com.
authors.forename: Jack M
authors.initials: JM
authors.lastname: Zuckerman
authors.affiliation: Department of Urology, Eastern Virginia Medical School, Norfolk, VA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Henderson
authors.affiliation: Department of Urology, Eastern Virginia Medical School, Norfolk, VA.
authors.forename: Brooke
authors.initials: B
authors.lastname: Edwards
authors.affiliation: Department of Urology, Eastern Virginia Medical School, Norfolk, VA.
authors.forename: Kurt
authors.initials: K
authors.lastname: McCammon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male