Use of the Argus male sling in men with male stress urinary incontinence after prostate surgery: a systematic review

Introduction. Urinary incontinence (UI) is one of the main long-term complications following prostate surgery, whether for cancer-related or benign conditions. According to the literature, UI occurs in 1-10% of cases, though some studies report rates as high as 50%. One of the surgical option for UI is the placement of a male sling. Despite the low level of evidence attributed to this method, interest in and the desire to utilize a less invasive procedure (compared to an artificial urinary sphincter) have persisted for decades. To our knowledge, no systematic reviews and analysis of studies on the use of the Argus male sling, via transobturator and retropubic approaches, has been conducted. Materials and Methods. The systematic review search strategy was conducted according to PICOs criteria. Studies included those involving the treatment of patients with any degree of urinary incontinence following any type of prostate surgery. Abstracts, case reports, retrospective and prospective analyses, and randomized trials were included. The primary objective was to assess all effectiveness indicators: the percentage of complete continence achieved, improvement (reduction in the number of pads used, results of the 1-hour/24-hour pad test). Secondary endpoints included adjustment rates, complications, and explantations. Results. A total of 28 studies were included. The predominant etiology was UI following radical prostatectomy (35.2-100% of patients in the studies), with surgical interventions for benign prostatic hyperplasia (adenomectomy, transurethral resection, enucleation) being the second most common etiological factor. Stratification by severity of UI showed mild cases in 6.9-37.5%, moderate in 16.7-81.25%, and severe in 6.25-80.5%. The overall effectiveness in the studies ranged from 25-100%, with «dry/complete cure» groups ranging from 12.5-90%. Adjustments were performed in 6.25-89.8% of cases, explantations in 0-35%, and complications in 0-83%. Conclusions. The Argus male sling as a surgical method for treating urinary incontinence after prostate interventions is an effective and safe procedure. The correction rate varies widely, with an acceptable level of complications and explantations. However, a significant drawback of the literature is the low reliability of the studies. Given this, further research on the Argus male sling is necessary.