We have recently analyzed our experience performing salvage AdVance male slings in patients who failed after an initial sling placement. After an initial experience with a few patients, our anecdotal hypothesis was that men who failed early or who never achieved success would do better with a salvage sling.
Our rationale, inappropriately so it turns out, was that men failing early likely exerted themselves too much or had the sling placed improperly during the initial surgery. Quite differently, however, we found that men with prolonged initial success before failure did better with a salvage sling. It is likely that men failing early may have been poor sling candidates in the first place and a salvage sling is simply an act in futility for these patients.
It remains our recommendation to perform artificial sphincter placement for men who fail an initial attempt at male sling placement for post-prostatectomy incontinence. An AUS gives the best chance for long-term success in this group of patients. For men refusing AUS placement we still offer a salvage AdVance sling only in men without a history of radiation therapy who do not suffer from severe incontinence (less than approximately 3 pads per day). We also use the results presented in this publication for more accurate counseling. We are now able to educate men who fail very early following AdVance placement that they are unlikely to benefit from a salvage male sling.