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Argus — Adjustable Suburethral Compression Sling

The Argus sling (Promedon, Córdoba, Argentina; first reported by Romano in 2006) is an adjustable, compressive suburethral sling with two variants: the Argus Classic (retropubic) and the Argus T (transobturator). Postoperative adjustment is mechanical, using radio-opaque silicone washers, and re-tensioning requires a minor surgical procedure. ATOMS, by contrast, is adjusted percutaneously through a port.[1][9]

For positioning versus other male slings, see Male Urethral Slings — chooser.

Promedon lists untreated urinary tract infection, anticoagulant therapy, urinary tract obstruction, renal insufficiency and autoimmune disease affecting connective tissue as main contraindications to Argus implantation. Confirm applicability against the current model-specific instructions for use.[9]

Argus cohorts report erosion, pain and explantation, with variation by center and route.[1][8]

Device design​

  • A radio-opaque silicone foam cushion pad (42 × 26 × 9 mm) provides soft bulbar compression.
  • The pad is attached to two silicone columns formed by multiple conical elements.
  • The 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, and 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; 74 Classic and 32 T, median follow-up 44 months) found nonsignificant trends favoring the Classic:[2]

  • Dry rates were 33.3% (Classic) versus 11.8% (T), p = 0.114.[2]
  • The postoperative 24-hour pad test was 71 versus 160 g, p = 0.066.
  • Explantation was 14.0% versus 23.3%, p = 0.371.[2]
  • Inguinal pain was significantly more frequent with the Argus T (p = 0.033).
  • Kaplan-Meier device survival favored the Classic (p = 0.198).
  • In multivariable analysis the Argus T was not an independent predictor of lower success (OR 0.587, 95% CI 0.166–2.076).[2]

Surgical technique​

  • Lithotomy; perineal incision.
  • For Classic, Promedon's 2013 quick guide instructs preservation of the bulbospongiosus muscle and central tendon, with the cushion against the intact muscle at the bulbar urethra before applying tension.[14] The Argus T technique also leaves the bulbospongiosus intact and positions the sling over it.[13]
  • Pass the columns bilaterally with needles, retropubically (Classic) or through the obturator foramina (Argus T). For Classic, Promedon's 2013 quick guide directs the needles close to the posterior pubic surface and requires control cystoscopy after both passes to exclude bladder perforation. A retropubic Argus series also describes cystoscopic inspection of the urethra for injury.[15] Promedon’s 2013 quick guide targets retrograde adjustment pressure 10–15 cm H2O above the untensioned baseline without overtightening;[14] its 2017 ARGUS IFU recommends an adjusted pressure of 30–40 cm H2O.[17]
  • Place the washers and adjust them intraoperatively to reach the desired urethral compression.
  • Mean operative time was approximately 49 min (range 28–105) in the Hübner series.[3]
  • Postoperative readjustment repositions the washers in a minor surgical procedure. It was needed in 38.6% (Hübner) to 42.9% (Siracusano) of patients.[3][4]

Outcomes​

StudyVariantNFollow-upDry / successNote
Romano 2006 (Phase III)[1]Classic487.5 mo (mean)73% dry / 10% improvedICIQ-SF 19.2 → 4.0
Hübner 2011[3]Classic1012.1 yr (mean; median 2.2 yr)79.2% dry (80/101) on a 20-minute pad-weight test (0–1 g)I-QoL 28.8 → 63.2 (p < 0.001)
Bochove-Overgaauw 2011[5]Classic100 treated; 95 evaluable27 mo (median)72% study-defined success (68/95; 92% mild / 67% moderate / 67% severe)Observational severity subgroups
Bauer 2015[6]T4228.8 mo (mean)61.9% cured (26/42) (0–5 g/24-hour pad test)26.2% improved; cohort included patients after radiotherapy
Siracusano 2017 (multicenter)[4]T18222 mo (median)86.2% composite success (cured or improved; 95% mild / 78% moderate / 70% severe)61.2% composite success after radiotherapy; adjustment in 42.9%
Casteleijn 2021 (long-term)[7]T78 enrolled; 26 assessed at 5 yr3.2 yr median (range 2.5–6.1)63.6% immediate dry → 53.3% author-reported dry at 5 yr (26 assessed; rate denominator unclear)79.6% author-reported > 50% improvement at 5 yr (26 assessed; postprostatectomy radiotherapy excluded); 3/78 (3.8%) slings removed for infection and 2/78 (2.6%) original slings removed and replaced after column transection
Carvalho 2023 (prospective)[12]T37 implanted; 22 evaluated at 60 mo60 mo56.7% author-reported composite success (dry or >50% pad-test improvement; reported percentage does not reconcile with 37 implanted or 22 evaluated)Moderate/severe SUI after radical prostatectomy; 51% reported an adverse event and 8/37 (21.6%) required sling removal (infection/pain, fistula or granuloma/extrusion)
Loertzer 2020[2]Classic vs T106 included (74 Classic, 32 T; dry-rate denominators unclear)44 mo (median)33.3% vs 11.8% (zero pads/24 h)Classic favored

Complications — the central caveat​

Some Argus cohorts report substantial complications and explantation, with variation by center and implant route.

ComplicationReported range
Any reported complication or adverse eventArgus T: 14.3% postoperative complications in Siracusano (median 22 months)[4]; 50/78 (64.1%) in Casteleijn within six months (25/78 acute retention, 27/78 early perineal pain)[7]; and 51% in Carvalho during five-year follow-up[12]. Classic: 55% in Bochove (median 27 months)[5] and 83% (24/29) in Dalpiaz (median 35 months)[8]. Event definitions and follow-up differ.
Explantation14.0–35% (Classic)[2][8] / 9.3–23.3% (T)[4][2]; reimplantation 2.6% in the Casteleijn T cohort[7]
Erosion or infection requiring sling removalRomano's original Classic cohort had 3/48 urethral erosions requiring removal at mean 7.5 months.[1] At mean 45 months, 9/47 slings had been removed: six for erosion (four urethral, one bladder, one abdominal wall) and three for infection.[18] Dalpiaz reported urethral erosion in 3/29 Classic recipients.[8]
Acute urinary retention15–35% (Classic)[1][8]
Perineal / inguinal pain27% requiring continuous analgesics (Dalpiaz)[8] / inguinal pain more frequent with T[2]
Intraoperative urethral perforation6% (3/48; Romano Classic cohort)[1]
Bladder or external iliac-vein injury (Classic)In one 41-man retropubic Argus series, bladder perforation occurred in 5/41 (12.2%) and external iliac-vein injury in 2/41 (4.9%); one man had both injuries.[15]
Bowel injuryPotential risk of retropubic needle passage; no reliable Argus-specific rate established here

The most concerning data come from Dalpiaz 2011 (n = 29, median follow-up 35 months).[8] Twenty-four men (83%) had a complication, 35% had acute urinary retention, and 35% had the sling removed (urethral erosion, infection, dislocation, retention or pain).[8] Twenty-seven percent had significant perineal pain requiring continuous oral analgesics, 17% were dry and 72% were dissatisfied.[8] The authors concluded that "significant changes are warranted in the sling system and in the implantation technique."[8] Hübner 2011 reported 15.8% explantation, with 6 of 16 explantations occurring within the first 22 cases, a possible learning-curve signal.[3]

Predictors of failure​

  • Severity. Success falls with severity (mild 92–95%, moderate 67–78%, severe 67–70%).[4][5]
  • Prior pelvic radiotherapy. Study-defined composite success (cured or improved) was 61.2% in men with prior radiotherapy.[4] In a separate 41-man retropubic Classic series with five irradiated men, prior radiotherapy was associated with intraoperative complications in univariable analysis (OR 16.5, 95% CI 1.93–140.85).[15] Both external iliac-vein injuries occurred in men with prior radiotherapy and urethrotomy.[15]
  • Preoperative urinary loss. Men with a loss of 250 g or more had significantly less improvement than men with less than 250 g.[7]
  • Center experience. Loertzer enrolled patients from centers with more than 150 prior Argus implantations but did not compare outcomes by center volume. In Hübner's series, 6 of 16 explantations occurred within the first 22 cases, a possible learning-curve signal.[2][3]

Salvage after Argus failure​

In the Hübner 101-patient series, 16 slings were explanted; the abstract describes later treatment with seven AUS implants and five sling reimplantations.[3] For persistent or recurrent SUI after a sling, the AUA/GURS/SUFU 2024 guideline recommends AUS .[11]

Current positioning​

The Argus allows postoperative washer readjustment, but cohort reports describe substantial pain, erosion and explantation in some settings. ATOMS uses a port-based adjustment mechanism. In a 22-man randomized Argus T versus AdVance trial (11 per arm; nine Argus T patients assessed for cure criteria at 18 months), 24-hour pad weight fell significantly within the Argus T arm at 18 months, but between-arm cure criteria did not differ significantly.[13] Among the 11 Argus T recipients, three had transient retention requiring catheterization, four had prolonged pain (one underwent sling removal), and three had crural silicone-column extrusions; these counts can overlap.[13] In a multicenter cohort of 294 fixed and 176 adjustable male slings (not randomized; adjustable slings were used more often in irradiated and more severe patients), functional questionnaire outcomes did not differ among follow-up respondents (126 fixed, 78 adjustable), and infection (2.3% vs 0%) and pain (11.9% vs 1.7%) were more frequent with adjustable slings (pooled Argus and ATOMS).[10] The AUA/GURS/SUFU guideline (2024) recommends discussing the AUS for mild-to-severe SUI , advises against routinely implanting male slings for severe SUI , and recommends an AUS over a sling after radiotherapy .[11] The EAU 2026 male LUTS guideline assigns level 3 evidence to adjustable male-sling efficacy and makes no recommendation for adjustable slings because a benefit from adjustability over other slings has not been demonstrated.[16]

See Also​

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. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Promedon. ARGUS adjustable suburethral system product specifications and contraindications. Product page, accessed September 2026; not a substitute for current model-specific instructions for use.

10. Hüsch T, Kretschmer A, Obaje A, et al. Fixed or adjustable sling in the treatment of male stress urinary incontinence: results from a large cohort study. Transl Androl Urol. 2020;9(3):1099–1107. doi:10.21037/tau-19-852

11. Breyer BN, Kim SK, Kirkby E, et al. Updates to Incontinence After Prostate Treatment: AUA/GURS/SUFU Guideline (2024). J Urol. 2024;212(4):531–538. doi:10.1097/JU.0000000000004088

12. Carvalho AP, Silva AB, Lebani BR, et al. "Clinical and Urodynamic results of the Argus T® sling in moderate and severe male stress urinary incontinence after radical prostatectomy - a 5 year prospective study." Int Braz J Urol. 2023;49(4):452–461. doi:10.1590/S1677-5538.IBJU.2023.0003

13. Lima JPC, Pompeo ACL, Bezerra CA. "Argus T® versus Advance® Sling for postprostatectomy urinary incontinence: A randomized clinical trial." Int Braz J Urol. 2016;42(3):531–539. doi:10.1590/S1677-5538.IBJU.2015.0075

14. Promedon. "ARGUS adjustable system: quick guide, surgical technique." Rev 01; December 2, 2013. Manufacturer PDF.

15. Cerniauskiene A, Barisiene M, Bakavicius A, Kavaliauskaite R, Cekauskas A, Zelvys A. "Complications after male adjustable suburethral sling implantation." Wideochir Inne Tech Maloinwazyjne. 2020;15(3):496–502. doi:10.5114/aoms.2020.97413

16. European Association of Urology. "EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms (LUTS)." EAU Guidelines Office; 2026. Section 5.6.5.b.2.

17. Promedon. ARGUS Instructions for Use. M 30-15-2710, Rev 02; 13 October 2017, §2.5.4.2. Manufacturer IFU.

18. Romano SV, Metrebian SE, Vaz F, et al. "Resultados a largo plazo del estudio multicéntrico fase III del tratamiento de la incontinencia de orina post prostatectomía con un sling masculino ajustable: seguimiento mínimo 3 años." Actas Urol Esp. 2009;33(3):309–314. doi:10.1016/S0210-4806(09)74146-4