Selecting the best candidate for a male incontinence device or another: dream or nightmare?

Abstract

After initial encouraging results, the published outcomes of retrobulbar slings to treat postprostatectomy incontinence can be considered suboptimal for moderate-to-severe incontinence, especially in patients with high body mass index and previous radiotherapy (1). However, the artificial urinary sphincter (AUS) is not the single alternative for these patients as different options of adjustable systems remain. The adjustable transobturator male system (ATOMS) has shown interesting results and can be an option even in radiated patients (2, 3). Other adjustable systems, such as male readjustment mechanical external system (male-REEMEX), adjustable sling Argus and adjustable continence therapy (ProACT) have different modes of action, variable results and also different security profile. Systematic reviews and meta-analysis allow indirect comparison of these systems, and the definition of their risk of failure, surgical revision and device explant (4-6). However, in the absence of randomized comparative studies the definition of the best patient profile for each device is not easy.