Adjustable bulbourethral male sling: experience after 101 cases of moderate-to-severe male stress urinary incontinence.

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.