Argus — Adjustable Suburethral Compression Sling
The Argus sling (Promedon, Córdoba, Argentina; first described Romano 2006) is an adjustable, compressive suburethral sling that exists in two variants — the Argus Classic (retropubic) and the Argus T (transobturator). Its defining feature is mechanical postoperative adjustability via radio-opaque silicone washers; re-tensioning requires a minor surgical procedure (unlike ATOMS, which adjusts via percutaneous port).[1][2]
For positioning vs other male slings, see Male Urethral Slings — chooser.
Argus carries the highest complication burden of any modern male sling — particularly a unique urethral-erosion signal and high explantation rates. Outcomes vary dramatically by center experience.
Device design
- Radio-opaque silicone foam cushion pad (42 × 26 × 9 mm) for soft bulbar compression.
- Pad attached to two silicone columns formed by multiple conical elements.
- Columns pass to the abdominal wall (Classic) or through the obturator foramina (Argus T).
- Radio-opaque washers at the exit points regulate and maintain tension; fluoroscopy can verify position during follow-up.[1]
Argus Classic vs Argus T
The Argus T was introduced after the Classic to avoid retropubic-passage complications (bladder perforation, vascular injury). The largest comparative analysis (Loertzer 2020, n = 106, 44-mo median) found a trend favoring the Classic:[3]
- Dry rates 33.3% (Classic) vs 11.8% (T), p = 0.114
- 24-h pad test postop 71 vs 160 g, p = 0.066
- Explantation 14.0% vs 23.3%, p = 0.371
- Inguinal pain significantly higher with Argus T (p = 0.033)
- Kaplan-Meier device survival favored Classic (NS)
Surgical technique
- Lithotomy; perineal incision.
- Cushion positioned beneath the bulbar urethra.
- Columns passed bilaterally — retropubically (Classic) or through the obturator foramina (Argus T) — using needles.
- Washers placed and adjusted intraoperatively to achieve the desired urethral compression.
- Mean OR time ~ 49 min (range 28–105).[1][4]
- Postoperative readjustment requires a minor surgical procedure to reposition the washers; needed in 38.6–42.9% of patients.[4][5]
Outcomes
| Study | Variant | N | Follow-up | Dry / success | Note |
|---|---|---|---|---|---|
| Romano 2006 (Phase III)[1] | Classic | 48 | 7.5 mo | 73% dry / 10% improved | ICIQ-SF 19.2 → 4.0 |
| Hübner 2011[4] | Classic | 101 | 2.1 yr | 79.2% dry (pad 0–1 g) | I-QoL 28.8 → 63.2 (p < 0.001) |
| Bochove-Overgaauw 2011[6] | Classic | 100 | 27 mo | 72% overall (92% mild / 67% mod / 67% severe) | All-severity efficacy |
| Bauer 2015[7] | T | 42 | 28.8 mo | 61.9% cure | Effective even after radiotherapy |
| Siracusano 2017 (multicenter)[5] | T | 182 | 22 mo | 86.2% (95% mild / 78% mod / 70% severe) | 61.2% success in irradiated; adjustment in 42.9% |
| Casteleijn 2021 (long-term)[8] | T | 78 | 3.2 yr (up to 6.1) | 63.6% immediate dry → 53.3% dry at 5 yr | 79.6% > 50% improvement at 5 yr; reimplant only 2.6% |
| Loertzer 2020[3] | Classic vs T | 106 | 44 mo | 33.3% vs 11.8% (strict zero-pad) | Classic favored |
Complications — the central caveat
Argus carries a notably higher complication burden than non-adjustable male slings, and outcomes vary dramatically by center experience.
| Complication | Reported range |
|---|---|
| Overall complication rate | 14.3% (multicenter T) → 55–83% (single-center series) |
| Explantation | 14.0–35% (Classic) / 2.6–23.3% (T) |
| Urethral erosion | 3–10% (Classic) — unique among modern male slings |
| Acute urinary retention | 15–35% (Classic) |
| Significant perineal pain | 27% (Dalpiaz) / inguinal pain higher with T |
| Intraoperative urethral perforation | ~ 6% in some series |
| Bowel perforation | 2/18 in one early Argus Classic series[2] |
The most concerning data come from Dalpiaz 2011 (n = 29 Argus Classic, 35-mo median): 83% complication rate, 35% AUR, 35% sling removal (urethral erosion / infection / dislocation / retention / pain), 27% significant perineal pain requiring continuous analgesia, ureteral reimplantation in one patient for ureteral erosion from a dislocated sling, 17% dry, 72% dissatisfied — leading the authors to conclude that "significant changes are warranted in the sling system and in the implantation technique."[9] Hübner 2011 also reported a 15.8% explantation rate, with 6 of 16 explantations occurring within the first 22 cases — a strong learning-curve signal.[4]
Predictors of failure
- Severity — strong gradient (mild 92–95%, moderate 67–78%, severe 67–70%).[5][6]
- Prior pelvic radiotherapy — success drops to ~ 61% irradiated.[5]
- Preoperative urinary loss ≥ 250 g — significantly worse outcomes.[8]
- Center volume / learning curve — Loertzer 2020 required > 150 prior implantations for inclusion; Hübner 2011 explant signal concentrated in early cases.[3][4]
Salvage after Argus failure
In the Hübner 101-pt series, 13 of 16 explanted patients received successful subsequent treatment — 7 AUS and 5 sling reimplantation.[4]
Current positioning
The Argus occupies a diminishing role in contemporary male SUI care. Its theoretical advantage (adjustability across all severity strata) is offset by the highest complication burden of any modern male sling — particularly the unique urethral-erosion signal, high explantation rates, and significant perineal pain. The ATOMS has largely superseded the Argus in many European centers because it offers easier office-based adjustability (percutaneous port vs surgical washer repositioning), lower complication rates, and more consistent center-to-center outcomes. The Argus remains in use primarily in Europe and South America, with the strongest case in moderate-to-severe SUI when AUS is unavailable or contraindicated.
See Also
- Male Urethral Slings — chooser
- ATOMS Sling — superior adjustable alternative
- REMEEX Male Readjustable Sling
- Artificial Urinary Sphincter (AUS)
References
1. Romano SV, Metrebian SE, Vaz F, et al. An adjustable male sling for treating urinary incontinence after prostatectomy: a phase III multicentre trial. BJU Int. 2006;97(3):533–539. doi:10.1111/j.1464-410X.2006.06002.x
2. Silva LA, Andriolo RB, Atallah ÁN, da Silva EM. Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery. Cochrane Database Syst Rev. 2014;(9):CD008306. doi:10.1002/14651858.CD008306.pub3
3. Loertzer H, Huesch T, Kirschner-Hermanns R, et al. Retropubic vs transobturator Argus adjustable male sling: results from a multicenter study. Neurourol Urodyn. 2020;39(3):987–993. doi:10.1002/nau.24316
4. Hübner WA, Gallistl H, Rutkowski M, Huber ER. Adjustable bulbourethral male sling: experience after 101 cases of moderate-to-severe male stress urinary incontinence. BJU Int. 2011;107(5):777–782. doi:10.1111/j.1464-410X.2010.09619.x
5. Siracusano S, Visalli F, Favro M, et al. Argus-T sling in 182 male patients: short-term results of a multicenter study. Urology. 2017;110:177–183. doi:10.1016/j.urology.2017.07.058
6. Bochove-Overgaauw DM, Schrier BP. An adjustable sling for the treatment of all degrees of male stress urinary incontinence: retrospective evaluation of efficacy and complications after a minimal followup of 14 months. J Urol. 2011;185(4):1363–1368. doi:10.1016/j.juro.2010.11.075
7. Bauer RM, Rutkowski M, Kretschmer A, et al. Efficacy and complications of the adjustable sling system ArgusT for male incontinence: results of a prospective 2-center study. Urology. 2015;85(2):316–320. doi:10.1016/j.urology.2014.10.019
8. Casteleijn NF, Cornel EB. Argus-T adjustable male sling: a follow-up study on urinary incontinence and patient's satisfaction. Neurourol Urodyn. 2021;40(3):802–809. doi:10.1002/nau.24619
9. Dalpiaz O, Knopf HJ, Orth S, et al. Mid-term complications after placement of the male adjustable suburethral sling: a single center experience. J Urol. 2011;186(2):604–609. doi:10.1016/j.juro.2011.03.131