2010 BJU INTERNATIONAL
Adjustable bulbourethral male sling: experience after 101 cases of moderate-to-severe male stress urinary incontinence
Wilhelm A. Hübner, Helmut Gallistl, Michael Rutkowski and Erik R. Huber
Department of Urology and Andrology,Clinic Korneuburg, Austria
Accepted for publication 1 April 2010
Study Type – Therapy (case series) Level of Evidence 4 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 tothe 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 transurethralresection 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. • Adjustmentwas 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 representthe ‘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 scoreimproved 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 radiationtreatment.
KEYWORDS radical prostatectomy, male urinary incontinence, stress urinary incontinence, adjustable male sling
INTRODUCTION The estimated incidence of stress urinary incontinence (SUI) after prostate surgery ranges widely from 3% to 60% of men [1–3]. Although SUI is rare after TURP, open prostatectomy and even radical prostatectomy (RP) it can nevertheless have devastating effects onpostoperative healthrelated quality of life. Current surgical therapies for SUI in men include the artiﬁcial urinary sphincter (AUS, AMS 800®; American
Medical Systems, USA) as the proposed ‘gold standard’ for post-prostatectomy SUI [4–6], the minimally invasive ProACT® (Uromedica, Plymouth, MN, USA) adjustable balloons  and the adjustable REMEEX® sling (Neomedic International, Barcelona,...