Original Article: Clinical Investigation Salvage autologous fascial sling after failed synthetic midurethral sling: Greater than 3-year outcomes Steven P Petrou, 1 Andrew J Davidiuk, 1 Bhupendra Rawal, 2,4 Michelle Arnold 3 and David D Thiel 1 1 Department of Urology, 2 Division of Biomedical Statistics and Informatics, 3 Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, and 4 Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA Abbreviations & Acronyms AFS = autologous fascial sling ISI = Incontinence Severity Index MUS = synthetic midurethral sling PGI-I = Patient Global Impression of Improvement RP = retropubic UI = urinary incontinence VLLP = Valsalva leak point pressure Correspondence: Steven P Petrou M.D., Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA. Email: petrou. steven@mayo.edu Received 28 April 2015; accepted 4 October 2015. Online publication 13 November 2015 Objective: To determine long-term surgical outcomes of salvage autologous fascial sling placement after a failed synthetic midurethral sling. Methods: Women who had undergone autologous fascial sling placement without concomitant pelvic surgery for a failed synthetic midurethral sling utilizing mesh with a minimum follow up of 36 months were identified. Charts were reviewed, and patients were contacted by telephone. Success was determined by the Patient Global Impression of Improvement. Secondary measures included the Incontinence Severity Index questionnaire, patient recommendation of the autologous fascial sling and need for further incontinence surgery. Results: A total of 35 patients met the criteria, and 21 were successfully contacted. Of those contacted, the median age at surgery was 67 years (range 53–81 years) and at the time of the survey was 75 years (range 63–84 years) with median follow up of 74 months (range 36–127 years). Preoperatively, 12 patients (57.1%) had urethral hypermobility and 13 patients (61.9%) had mixed urinary incontinence. Eight patients (38.1%) had concomitant sling excision with five of those combined with urethrolysis at the time of the salvage operation. Patient Global Impression of Improvement success was noted in 16 patients (76.2%). A total of 11 patients (52.4%) were dry or had slight incontinence by the Incontinence Severity Index. One patient required additional anti- incontinence surgery (4.8%). A total of 18 patients (85.7%) recommended the autologous fascial sling. No statistical impact was noted with sling excision (P = 0.62), mixed urinary incontinence (P = 0.61), age at surgery (P = 0.23), age at follow up (P = 0.15), length of follow up (P = 0.71) or first surgery type (transobturator tape vs retropubic; P = 1.00). Conclusions: Autologous fascial sling provides reasonable long-term success as a salvage operation for failed midurethral slings. Key words: autologous fascial sling, failed midurethral sling, recurrent stress urinary incontinence, repeat sling, salvage fascial sling. Introduction There is continued clinical discussion regarding the treatment of female patients who have recurrent stress urinary incontinence after a failed primary midurethral sling using mesh. Treatment options described in the literature include injectable therapy, repeat synthetic mid- urethral sling and a RP sling utilizing mesh or autologous fascia. 1 There might be patients who would be best served by a repeat sling, but who do not want more mesh, in which case an AFS might be offered. Milose et al. have reported a success rate of 69.7% for AFS after failed midurethral synthetic sling at a mean follow up of 14.5 months. 2 We report on the three-or-more-year outcomes of a population of women treated with AFS after failed synthetic midurethral slings. Methods Institutional review board approval was obtained for the present retrospective study. Long- term follow up was defined by a minimum follow up of at least 36 months. Surgical logs were reviewed, and female patients who had undergone a repeat AFS for a failed primary sling utilizing mesh more than 3 years (36 months) prior were identified. Failed primary sling 178 © 2015 The Japanese Urological Association International Journal of Urology (2016) 23, 178--181 doi: 10.1111/iju.13003