According to the SATURN registry adjustable systems such as, Argus, Atoms and ProAct, roughly represent 10% of surgeries for male incontinence. Limitations can be the way of adjustment, insufficient contact to the urethra or simply unsatisfactory continence results. Vulko is an adjustable sling that provides a direct upright vector for urethral coaptation and easy adjustment, resulting in consistent resistance when needed. The primary aim is to present the preliminary results in terms of continence. The secondary aim is in terms of early complications.

We present the data of the Vulko system (Promedon, Argentina) in 14 patients with moderate to severe stress urinary incontinence, from Sept 2022 to Aug 2023 in three centers. A vertical incision was made over the urethral bulb, and the triangular space between the bulb and ischiopubic ramus was dissected. Two transverse suprapubic incisions were made. The pad was filled with 5ml of solution. The instrument was inserted through the perineal incision and advanced to the suprapubic incision. A cystoscopy was performed, and the optic and camera removed, leaving the cystoscope sheath in place to perform the positioning and adjustment of the sling. The arms were pulled out until the pad touches the bulbospongiosus muscle, and the protective sheets were removed. Washers were pulled down until the the rectus fascia. 3 ml of solution was removed, leaving 2 ml in the pad. A scrotal subcutaneous pouch was created to place the port. Each surgeon was responsible for collecting the data regarding surgery date, duration, preoperative and postoperative continence level in pads/day, at different intervals. Postoperative symptoms, adverse events, and ambulatory adjustments were recorded. Complications were assessed according to the Clavien-Dindo classification (CDC).

Patients presented moderate to severe SUI (3-5 pads/day). The interventions lasted after 55 (41-73) min. No serious complications were observed in the intraoperative and postoperative period. Patients exhibited symptoms of dysuria (5), weak urine stream (6), perineal pain (8-managed with oral medication), and retention (2), foley catheter had to be re-introduced for 10 days. All the complications above are CDC grade I. 4 patients received ambulatory adjustments, 3 at the first month, and 1 after 5 months with 2-3ml, achieving continence afterwards. After 6.7 (1-12) months FU, continence was achieved for 11/12 patients with 0 pad, 1/12 continued using 1 pad/day without ambulatory adjustment.

A dry rate of 92% could be achieved in this cohort with no serious complications. Despite short follow-up and the small cohort the results are promising.

The Vulko sling seems to be effective and the adjustment can be done easily. The implantation procedure is in accordance with former surgical techniques, and the initial results are promising. Larger series are necessary to confirm these findings.