Adjustable bulbourethral male sling: Experience after 30 cases of moderate to severe male stress urinary incontinence

Abstract

Objective: To report our experience using the Argus perineal sling from July 2015 to April 2018 for male stress urinary incontinence (SUI) after prostatic surgery. To evaluate the safety, efficacy and healthrelated quality of life in patients undergoing this procedure. Patients and methods: The positioning of an adjustable bulbourethral male sling provides a perineal incision, exposure of the bulbospongiosus muscle and the application of the sling bearing on it with transobturator passage of the two extremities with out-in technique. To modulate the bearing tension on the urethra, with a rigid cystoscope the Retrogade Leak Point Pressure is measured, increasing it by 10-15 cm of H20 from baseline. We retrospectively evaluated the results of this implant performed by the same operator on 30 patients who presented post-operative SUI from medium to severe (> = 2 pads/day, pad test at one hour > = 11 g). Mean operative time and possible intra and postoperative complications were evaluated. Postoperatively each patient was reassessed according to the following parameters: number of pads consumed/ die, pad tesy at one hour, ICQS-F, any related side effects. Results: After the intervention, 21 of 30 patients (70% of the total) were totally continent (< 1 pad / day, pad test at 1 h < 1-2 g, ICQS-F < 11), out of them 4 required a single adjustment at 3 months in order to achieve this result. 9 of 30 patients (30 %) achieved a clinically significant improvement without obtaining total continence (mean reduction of the n° pads/day: -2.5 ± 1 DS; average reduction of the pad test at 1 h: -20 g ± 4 DS; ICQS-F average reduction: -6 points ± 2 DS), out of them 5 required a 3 month adjustment to obtain these improvements resulting, 4 needed 2 adjustments resulting because the first adjustment was not satisfactory and one who ameliorated from severe to moderate incontinence decided to live in this clinical condition. Conclusions: The results of our study show that the positioning of this sling represents a valid treatment for the moderate and severe post-surgical male SUI. The possibility of adjusting the tension of the sleeve in a "second look" makes the intervention adaptable according to the results obtained. Only multicentric clinical trials on larger series would clarify and eventually confirm the clinical benefits of this sling in post-surgical male SUI.

A biofeedback‐guided programme or pelvic floor muscle electric stimulation can improve early recovery of urinary continence after radical prostatectomy: A meta‐analysis and systematic review

“…36,37 Similarly, in the RP setting for PC, several well-established patient disease-specific, psychological as well as pathological features may condition UI after RP. 38,39 Unfortunately, these variables were not addressed or not adequately classified by all the selected studies as data regarding pre-operative conditions, co-morbidities, prostate volume and surgical techniques used to reduce the incidence of post-RP UI are incomplete. All these variables likely conditioned the heterogeneity of UI levels detected in terms of pad weight at baseline after catheter removal.…”

Contemporary male slings for stress urinary incontinence: advances in device technology and refinements in surgical techniques

“…[8][9][10] However, complications such as sling erosion or infection are not uncommon and the device explantation rate remains quite high (up to 16%). [11][12][13][14][15] Remeex sling (Neomedic, Barcelona, Spain) Manufacturer and device specifications. The Remeex sling, also known as the REadjustable MEchanical EXternal device, is manufactured by Neomedic in 2004.…”

Narrative review of male urethral sling for post-prostatectomy stress incontinence: sling type, patient selection, and clinical applications

“…In looking at the Argus sling, Cotugno et al reported a short-term study at 3 months post-operation that 70% (21 patients) reached total continence defined as using less than one PPD (58). The remaining 30% (9 patients) were noted as having a clinically significant improvement (58).…”

“…In looking at the Argus sling, Cotugno et al reported a short-term study at 3 months post-operation that 70% (21 patients) reached total continence defined as using less than one PPD (58). The remaining 30% (9 patients) were noted as having a clinically significant improvement (58). Looking at differences in outcome due to preoperative conditions, Bochove-Overgaauw et al reported differences of 92% (12 of 13), 67% (29 of 43), and 67% (26 of 39) in the mild, moderate, and severe incontinence group (59).…”