title: The Artificial Urinary Sphincter is Superior to a Secondary Transobturator Male Sling in Cases of a Primary Sling Failure.
abstract: OBJECTIVE
  We compared continence outcomes in patients with post-prostatectomy stress urinary incontinence treated with a salvage artificial urinary sphincter vs a secondary transobturator sling.
  
  
  METHODS
  We retrospectively reviewed the records of patients undergoing salvage procedures after sling failure from 2006 to 2012. Postoperative success was defined as the use of 0 or 1 pad, a negative stress test and pad weight less than 8 gm per day. We performed the Wilcoxon test and used a Cox regression model and Kaplan-Meier survival analysis.
  
  
  RESULTS
  A total of 61 men presenting with sling failure were included in study, of whom 32 went directly to an artificial urinary sphincter and 29 received a secondary sling. Of the artificial urinary sphincter cohort 47% underwent prior external beam radiation therapy vs 17% of the secondary sling cohort (p = 0.01). Average preoperative 24 hour pad weight and pad number were higher in the artificial urinary sphincter cohort. Median followup in artificial urinary sphincter and secondary sling cases was 4.5 (IQR 4-12) and 4 months (IQR 1-5), respectively. Overall treatment failure was seen in 55% of patients (16 of 29) with a secondary sling vs 6% (2 of 32) with an artificial urinary sphincter (unadjusted HR 7, 95% CI 2-32 and adjusted HR 6, 95% CI 1-31).
  
  
  CONCLUSIONS
  In this cohort of patients with post-prostatectomy stress urinary incontinence and a failed primary sling those who underwent a secondary sling procedure were up to 6 times more likely to have persistent incontinence vs those who underwent artificial urinary sphincter placement. These data are useful for counseling patients and planning surgery. We currently recommend placement of an artificial urinary sphincter for patients in whom an initial sling has failed.
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: divya.ajay@duke.edu.
authors.forename: Divya
authors.initials: D
authors.lastname: Ajay
authors.affiliation: School of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Haijing
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Urology, University of Kentucky, Lexington, Kentucky.
authors.forename: Shubham
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: John P
authors.initials: JP
authors.lastname: Selph
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Belsante
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Aaron C
authors.initials: AC
authors.lastname: Lentz
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: George D
authors.initials: GD
authors.lastname: Webster
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Peterson
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D013521:Urologic Surgical Procedures, Male
keywords: artificial; prostatectomy; stress; suburethral slings; urethra; urinary incontinence; urinary sphincter