Adjustable bulbourethral male sling: experience after 101 cases of moderate‐to‐severe male stress urinary incontinence
Authors: Hübner Wilhelm A. , Gallistl Helmut , Rutkowski Michael , Huber Erik R. 
Published: October 2010

Study Type – Therapy (case series)Level of Evidence 4 What’s known on the subject? and What does the study add? First data on the ARGUS® sling was published in 2006 by Romano SV et al. as a multicentre study, evaluating the data of 48 patients with a mean follow up (FU) of 7.5 months, with the conclusion that this new adjustable sling was effective in treatment of SUI and the complication rate was acceptable. In 2009, Romano SV et al. published a long‐term FU (mean: 45 months) of the same patient group, demonstrating the long‐term efficacy of the sling.Our study evaluated the data of 101 cases of moderate to severe male stress urinary incontinence (SUI) after implantation of the ARGUS® sling at mean follow‐up of 2.1 (0.1–4.5) years. In addition we made a subgroup analysis of representative “index patients”, patients after external beam radiation therapy (EBRT) and of a subgroup after differentiation of the retrograde leak point pressure (RLPP).OBJECTIVES

To report our experience using an adjustable bulbourethral sling since April 2005 for male stress urinary incontinence (SUI) after prostatic surgery.
To evaluate the safety, efficacy and health‐related quality of life in recipients of the Argus® (Promedon SA; Cordoba, Argentina) adjustable bulbourethral sling.

PATIENTS AND METHODS

Between April 2005 and April 2009, 101 men with moderate‐to‐severe SUI after prostatic surgery were implanted with the Argus sling.
The radio‐opaque Argus system comprises a thick silicone‐foam pad for soft bulbar urethral support. The pad is attached to silicone columns that, after being passed with needles from the perineum to the abdominal wall, are adjusted with silicone washers to maintain the desired position.
Between prostatic surgery and Argus sling placement, most patients (74.3%) had undergone various procedures for SUI or bladder neck pathologies: 22 had undergone secondary irradiation therapy after surgery (19 after retropubic radical prostatectomy [RP], one after perineal RP and two after transurethral resection of the prostate).
All patients were evaluated before and after sling placement with 20‐min pad tests, the Urinary Incontinence Quality of Life Scale (I‐QoL), cystoscopy and uroflowmetry. The study was designed in a retrospective longitudinal fashion.

RESULTS

The mean (range) follow‐up was 2.1 (0.1–4.5) years. The mean (range) sling surgery duration was 49 (28–105) min.
Adjustment was necessary in 39 cases (38.6%), either loosening (10/101; 9.9%) or tightening (29/101; 28.7%) at a mean of 104.3 (14–910) days after the initial implantation.
The sling had to be removed in 16/101 patients (15.8%) at a mean of 371.1 (20–1260) days after implantation due to urethral erosion or infection. However, six of the 16 patients were within the first 22 placements and probably represent the ‘learning curve’. In all, 13 of these patients received later successful treatment (seven with an artificial urinary sphincter, five with re‐implantation of the sling). Four of these patients were lost for follow‐up.
After a median (mean) follow‐up of 2.2 (2.1) years, 80/101 (79.2%) patients were considered as dry, with a pad test of 0–1 g (70 patients, 0 g; 10 patients, 1 g). The I‐QoL score improved from a mean of 28.8 (14.5–61.8) to 63.2 (16.4–115) points after sling placement.
Both the 20‐min pad‐weight tests and I‐QoL responses improved significantly compared with baseline (P < 0.001).

CONCLUSION

We think that the Argus male bulbourethral sling system is an excellent first‐ or second‐line treatment for moderate‐to‐severe male SUI, even after external beam radiation treatment.