Reconstruction and Salvage of Failed Male Urethral Slings

  • Jack M. Zuckerman
  • Kurt McCammon
Part of the Current Clinical Urology book series (CCU)


Male urethral slings are becoming an accepted treatment for men with persistent post-prostatectomy incontinence (PPI) who do not desire, or are not candidates for artificial urinary sphincters (AUS). Initial and midterm results following AdVance sling placement have been encouraging, with success rates approaching 70–80 %. Patients with persistent or recurrent PPI following sling placement may be candidates for salvage treatments, depending on patient preference. After removal of the original mesh, repeat AdVance slings are placed in a similar manner to the primary procedure, other than being placed more distal on the corpus spongiosum. Patients competent and willing to operate an AUS may undergo AUS placement following failed AdVance. This is easily accomplished without removing the sling mesh, by placing the cuff around the spongiosum distal to the urethral sling. Early success rates following repeat AdVance placement has approached 70 %, and success following salvage AUS is expected to be similar to a primary AUS placement.


Stress Urinary Incontinence Artificial Urinary Sphincter Sling Placement Bladder Neck Contracture Corpus Spongiosum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Liss MA, Osann K, Canvasser N, et al. Continence definition after radical prostatectomy using urinary quality of life: evaluation of patient reported validated questionnaires. J Urol. 2010;183:1464.PubMedCrossRefGoogle Scholar
  2. 2.
    Smither AR, Guralnick ML, Davis NB, et al. Quantifying the natural history of post-radical prostatectomy incontinence using objective pad test data. BMC Urol. 2007;7:2.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Parker WR, Wang R, He C, et al. Five year expanded prostate cancer index composite-based quality of life outcomes after prostatectomy for localized prostate cancer. BJU Int. 2011;107:585.PubMedCrossRefGoogle Scholar
  4. 4.
    Penson DF, McLerran D, Feng Z, et al. 5-year urinary and sexual outcomes after radical prostatectomy: results from the prostate cancer outcomes study. J Urol. 2005;173:1701.PubMedCrossRefGoogle Scholar
  5. 5.
    Bauer RM, Bastian PJ, Gozzi C, et al. Postprostatectomy incontinence: all about diagnosis and management. Eur Urol. 2009;55:322.PubMedCrossRefGoogle Scholar
  6. 6.
    Catalona WJ, Carvalhal GF, Mager DE, et al. Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol. 1999;162:433.PubMedCrossRefGoogle Scholar
  7. 7.
    Kao TC, Cruess DF, Garner D, et al. Multicenter patient self-reporting questionnaire on impotence, incontinence and stricture after radical prostatectomy. J Urol. 2000;163:858.PubMedCrossRefGoogle Scholar
  8. 8.
    Stanford JL, Feng Z, Hamilton AS, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA. 2000;283:354.PubMedCrossRefGoogle Scholar
  9. 9.
    Wei JT, Montie JE. Comparison of patients’ and physicians’ rating of urinary incontinence following radical prostatectomy. Semin Urol Oncol. 2000;18:76.PubMedGoogle Scholar
  10. 10.
    Rehder P, Gozzi C. Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy. Eur Urol. 2007;52:860.PubMedCrossRefGoogle Scholar
  11. 11.
    Bauer RM, Soljanik I, Fullhase C, et al. Mid-term results for the retroluminar transobturator sling suspension for stress urinary incontinence after prostatectomy. BJU Int. 2011;108:94–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Cornu JN, Sebe P, Ciofu C, et al. Mid-term evaluation of the transobturator male sling for post-prostatectomy incontinence: focus on prognostic factors. BJU Int. 2011;108:236–40.PubMedCrossRefGoogle Scholar
  13. 13.
    Gozzi C, Becker AJ, Bauer R, et al. Early results of transobturator sling suspension for male urinary incontinence following radical prostatectomy. Eur Urol. 2008;54:960.PubMedCrossRefGoogle Scholar
  14. 14.
    Bauer RM, Mayer ME, Gratzke C, et al. Prospective evaluation of the functional sling suspension for male postprostatectomy stress urinary incontinence: results after 1 year. Eur Urol. 2009;56:928.PubMedCrossRefGoogle Scholar
  15. 15.
    Cornu JN, Sebe P, Ciofu C, et al. The AdVance transobturator male sling for postprostatectomy incontinence: clinical results of a prospective evaluation after a minimum follow-up of 6 months. Eur Urol. 2009;56:923.PubMedCrossRefGoogle Scholar
  16. 16.
    Davies TO, Bepple JL, McCammon KA. Urodynamic changes and initial results of the AdVance male sling. Urology. 2009;74:354.PubMedCrossRefGoogle Scholar
  17. 17.
    Cornel EB, Elzevier HW, Putter H. Can advance transobturator sling suspension cure male urinary postoperative stress incontinence? J Urol. 2010;183:1459.PubMedCrossRefGoogle Scholar
  18. 18.
    Gill BC, Swartz MA, Klein JB, et al. Patient perceived effectiveness of a new male sling as treatment for post-prostatectomy incontinence. J Urol. 2010;183: 247.PubMedCrossRefGoogle Scholar
  19. 19.
    Rehder P, Mitterberger MJ, Pichler R, et al. The 1 year outcome of the transobturator retroluminal repositioning sling in the treatment of male stress urinary incontinence. BJU Int. 2010;106:1668.PubMedCrossRefGoogle Scholar
  20. 20.
    Al-Najar A, Kaufmann S, Boy S, et al. Management of recurrent post-prostatectomy incontinence after previous failed retrourethral male slings. Can Urol Assoc J. 2011;5:107.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Kim SP, Sarmast Z, Daignault S, et al. Long-term durability and functional outcomes among patients with artificial urinary sphincters: a 10-year retrospective review from the University of Michigan. J Urol. 2008;179:1912.PubMedCrossRefGoogle Scholar
  22. 22.
    Bauer RM, Mayer ME, May F, et al. Complications of the AdVance transobturator male sling in the treatment of male stress urinary incontinence. Urology. 2010;75:1494.PubMedCrossRefGoogle Scholar
  23. 23.
    Soljanik I, Becker AJ, Stief CG, et al. Repeat retrourethral transobturator sling in the management of recurrent postprostatectomy stress urinary incontinence after failed first male sling. Eur Urol. 2010;58: 767–72.PubMedCrossRefGoogle Scholar
  24. 24.
    Harris SE, Guralnick ML, O’Connor RC. Urethral erosion of transobturator male sling. Urology. 2009;73:443 e19.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jack M. Zuckerman
    • 1
  • Kurt McCammon
    • 1
  1. 1.Department of UrologyEastern Virginia Medical SchoolNorfolkUSA

Personalised recommendations