Comparison of adjustable male slings and artificial urinary sphincter in the treatment of male urinary incontinence: a retrospective analysis of patient selection and postoperative continence status

Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter

“…In our experience both ATOMS and AUS are effective treatments for PPI with similar results in terms of achieving dryness and patient satisfaction. As was demonstrated in the retrospective comparison between AUS and adjustable slings (mixture of Argus and ATOMS) in the DOMINO registry, patients selected for AUS implantation are those with a more severe grade of PPI [27]. The magnitude of therapeutic effect (changes in the 24-h pad test and pad count and ICIQ-SF evaluation) is larger for AUS, as this device is preferred for patients with higher severity of sphincteric damage.…”

Patient Selection in Surgical Centers of Expertise in the Treatment of Patients with Moderate to Severe Male Urinary Stress Incontinence

“…Seventy-eight patients (88.6%) that underwent AUS implantation received postoperative antibiotics for a median of 8 days (1-25), and 53 patients (40.2%) that underwent implantation of an adjustable sling received postoperative antibiotics for a median of 5 days (1-20). The median postoperative time until catheter removal was 3 days [2][3][4][5][6][7][8][9][10][11][12][13][14][15] for patients receiving an AUS and 2 days [1][2][3][4][5][6][7][8][9][10][11] for patients receiving an adjustable sling.…”

“…Adjustable male slings are described as an alternative treatment option in male patients with stress urinary incontinence with high patient satisfaction [3,10]. Their mode of action is a permanent increase in urethral resis-tance to support basic continence, therefore creating a certain degree of obstruction in contrast to the fixed repositioning male sling system [13].…”

“…Interestingly, though postoperative results were comparable in both groups in the present study, in a prior publication of our study group including all patients, results clearly favored the AUS with a reduction in pad usage from approx. 7 to 1 pad per day and 6 to 2 pads per day for adjustable male slings, respectively [3]. This implies that the indications for adjustable slings may be better understood in centers of higher expertise, whilst in such centers the high rate of "salvage operations" negatively influences the postoperative results of AUS.…”

“…Adjustable male slings are an alternative surgical option in patients with male urinary incontinence with good results but without a high level of evidence regarding the optimal patient selection. Decision-making in patients with moderate to severe male incontinence therefore remains a challenging topic [1][2][3]. For the repositioning male sling system (AdVance or since 2010 AdVance XP), multiple preoperative factors for an impaired result, such as radiation therapy, could be identified, and in the preoperative setting, a functional cystoscopic assessment prior to surgery has been described as an effective tool for outcome prediction [4].…”