The use of adjustable bulbourethral male slings may be a promising alternative for the treatment of post-operative stress urinary incontinence (SUI). We report on our long-term experience regarding efficacy, safety and satisfaction in recipients of the Argus® sling.

In this retrospective, single center study conducted between March 2005 and September 2020, the data from 122 men with moderate-to-severe stress urinary incontinence, who underwent male Argus® sling implantation were collected. 24 patients (19,7%) had one and 20(16,4%) more than one previous incontinence surgeries, 25 patients had undergone previous external beam radiation (20,5%). 
Preoperative evaluation included urine culture, urethrocystoscopy, 24-h pad test (p/d). Postoperative evaluation included residual volume, VAS-scale and p/d, we also used a questionnaire to inquire about recipient’s satisfaction and quality of life (QoL). Continence was defined ≤1 pad per day (socially dry). Complications were graded using Clavien-Dindo scale.

115 patients (7 were lost to follow-up) were followed for a mean follow-up (FU) of 95 (±60) months (median 97). 75 (65,2%) were socially dry and a reduction of more than 50% in p/d was obtained in additional 11,3%. Adjustment was necessary in 53 cases (46,1%), either tightening (n=52) or loosening and the satisfaction rate was 96%.
Within the whole series 12 interoperative bladder perforations occurred (9,8%). In all cases, the needle was simply repositioned, and the catheter left in situ for 5 days. 
Complications included postoperative hematoma (n=12) and transient perineal or scrotal pain (n=11). Sling explantation was reported in 39 patients after a median of 40.7 months, mostly associated with persistence urinary incontinence (n=16) or urethral erosion (n=10). Other reasons for explantation were infection (n=6), subcutaneous dislocalisation of silicone columns (n=6) and 1 case of severe and prolonged pain. Explantation was reported in 17 cases within the first 3 years, another 22 slings were explanted after 3 to 13 years of sufficient function (median 6). In all 33 of these patients received later successful treatments for urinary incontinence (30 artificial urinary sphincter, 3 re-implantation of the sling).

The treatment of male stress urinary incontinence with ARGUS Sling provides high satisfaction rate and an improvement of pad per day usage over 50%, in 77% was reported in this cohort. With an acceptable complication rate and the option of minimal invasive adjustment to patient needs, the dives is a safe and efficient treatment for SUI.

The Argus® sling is an effective treatment option to achieve substantial long-term improvement of incontinence in patient with moderate-to-severe SUI.