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Male Continence Implant Devices (Sling Family)

Male suburethral implants differ in their material, anchoring route and adjustment mechanism. This page describes those differences. For patient selection, comparative outcomes and implantation, see Male Urethral Slings. The AUS and ProACT balloons have separate device pages.

The AUA/GURS/SUFU guideline supports discussing male slings for mild-to-moderate SUI and advises against their routine use for severe SUI. For SUI after radiotherapy it favors AUS over slings or adjustable balloons. These recommendations do not establish equivalence among every fixed and adjustable implant below.[1]

Device Family Overview​

DeviceComponents and principal actionPostoperative adjustment
AdVance / AdVance XP — Boston ScientificPolypropylene mesh with two transobturator arms; designed to reposition the bulbar urethraFixed after implantation
Virtue — ColoplastFour-arm polypropylene sling; two transobturator and two prepubic arms provide elevation and compressionFixed after implantation
ATOMS — A.M.I.Fillable silicone cushion, polypropylene transobturator anchoring and scrotal access portClinician adjusts cushion volume through the port
Argus / Argus T — PromedonSilicone foam pad, segmented silicone arms and retaining washers; retropubic and transobturator variantsWasher position can be changed, including after implantation, through a procedure to access the hardware
Remeex MRS — NeomedicPolypropylene tape connected by traction threads to a suprapubic mechanical regulator (varitensor)Clinician reconnects an external manipulator when later readjustment is needed

These are passive continence devices; adjustment is a clinician procedure, not a pump the patient must operate to void. Adjustable does not mean noninvasive, indefinitely effective or free from revision risk.[2][3][4][5][6]

Component and Handling Distinctions​

AdVance and AdVance XP​

The XP IFU describes permanent monofilament polypropylene mesh, tissue anchors molded into its arms, integrated tensioning fibers, and removable sheaths and liners. The anchors are not harpoon-tipped arms, and their presence does not eliminate migration or failure. The sling has no reservoir or adjustment port.[2]

The intended repositioning mechanism does not make excessive tension harmless: obstruction, retention, pain, erosion and tissue injury remain possible. The manufacturer's MR Safe designation applies to the specified sling implant; it should not be transferred to other sling systems containing metal components. The AdVance procedure page covers selection and implantation.[2]

Virtue​

Virtue combines transobturator and prepubic arms in a four-arm knitted monofilament polypropylene implant. Its compression and elevation mechanism differs from a two-arm repositioning sling. FDA clearance and the initial multinational study describe this device; neither proves that it provides superior continence to other implants. See Virtue Sling.[3][7]

ATOMS​

A fillable silicone cushion supports and compresses the bulbospongiosus region. Polypropylene arms provide transobturator fixation, while a scrotal port permits clinician adjustment using the specified noncoring needle. Port construction has changed across generations; identify the implanted model before planning adjustment. Use its IFU for fluid, needle, volume and timing limits. There is no universal fill-to-continence recipe for the entire family. See ATOMS.[4]

Argus​

Argus uses a silicone foam pad and segmented silicone arms held by washers; the manufacturer describes a mesh-free implant. Classic Argus follows a retropubic route, whereas Argus T uses transobturator fixation. Both routes should not be described as terminating in the same rectus-fascia plane.[5]

Postoperative adjustment is possible, but requires access to the washers rather than injection through a scrotal port. In an older retrospective 101-patient series, 39 men underwent adjustment; this establishes that adjustment occurred, not the probability of durable success for a current candidate. See Argus Sling.[8]

Remeex MRS​

The suprapubic regulator changes tension on the suburethral tape. An external manipulator is connected for clinician adjustment and subsequently removed; later adjustment requires reconnection through a procedure. It is not a permanent transcutaneous handle and should not be presented as unrestricted bedside readjustment without skin access. See Remeex MRS.[6][9]

Regulatory and Material Considerations​

AdVance XP and Virtue have FDA 510(k) clearances as Class II male incontinence meshes. This differs from premarket approval of hydraulic continence devices. The cited XP record identifies a US predicate cleared in 2018; a 2010 introduction date must not be presented as its US clearance date. The 2021 XP and 2023 Virtue submissions concern particular device changes, not new comparative efficacy trials.[10][3]

Availability, authorization and instructions vary by country and model. This overview does not establish current US authorization for ATOMS, Argus or Remeex, or current availability of legacy InVance and regional I-STOP TOMS devices. A CE mark, an adverse-event database entry or an overseas series does not establish US marketing authorization. Calling use “off-label” does not resolve access to an unapproved device.

Polypropylene is also used in female midurethral slings, but shared material does not make the devices' indications, regulatory classifications or restrictions identical. Consult the polypropylene mesh page and each implant's own labeling.

Device-Level Failure Modes​

Counsel about infection, pain, retention or obstruction, erosion or extrusion, migration, recurrent incontinence and possible revision or explantation. Port and cushion systems add leakage and port-related problems; mechanical regulators and washers add hardware-access and adjustment issues. Anchors and postoperative adjustability do not remove these risks. Device-specific incidence and treatment belong on the linked procedure pages.[2][3][5][6]

References​

1. AUA/GURS/SUFU. Incontinence After Prostate Treatment Guideline, amended 2024, statements 20–24. Guideline.

2. Boston Scientific. AdVance XP Male Sling System — Instructions for Use. 51117738-01A, April 2020, English section. Manufacturer IFU. Use the instructions supplied with the actual model.

3. US FDA. Virtue Male Sling and Alexis Implantation Kit, K231891 (2023). 510(k) summary.

4. A.M.I. Solutions for Urology. April 2024, ATOMS device section. Manufacturer brochure.

5. Promedon. Argus and Argus T — Adjustable Male Sling System. Current product description; device brochure. Accessed September 12, 2026.

6. Neomedic. Remeex Male — sistema reajustable. Manufacturer device description. Accessed September 12, 2026.

7. Comiter CV, Rhee EY, Tu LM, et al. The Virtue sling—a new quadratic sling for postprostatectomy incontinence—results of a multinational clinical trial. Urology. 2014;84(2):433–438. doi:10.1016/j.urology.2014.02.062.

8. 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):777–82. doi:10.1111/j.1464-410X.2010.09619.x

9. Sousa-Escandón A, Cabrera J, Mantovani F, et al. "Adjustable suburethral sling (male remeex system) in the treatment of male stress urinary incontinence: a multicentric European study." Eur Urol. 2007;52(5):1473–9. doi:10.1016/j.eururo.2007.05.017

10. US FDA. AdVance XP Male Sling System, K211847 (2021), including predicate K182169 cleared November 27, 2018. 510(k) summary.