Adjustable Continence Devices
Each adjustable male continence device now has its own canonical page. For the comparative chooser and decision matrix, see Male Urethral Slings — chooser.
Adjustability is attractive because post-prostatectomy SUI is not static: edema resolves, compression relaxes, radiation tissues change, and patient tolerance for obstruction varies. The tradeoff is that adjustable devices add device-specific failure modes — ports, washers, balloons, re-tensioning mechanisms, erosion, migration, and explantation.
| Device | Mechanism | Page |
|---|---|---|
| ATOMS | Adjustable ventral compression via subcutaneous port | atoms-sling |
| Argus (Classic / T) | Compression + mechanical washer adjustment | argus-sling |
| REMEEX (MRS) | Compression + suprapubic varitensor (non-invasive percutaneous re-tensioning) | remeex-mrs |
| ProACT | Periurethral balloon compression at the bladder neck | proact-balloons |
Practical Positioning
| Scenario | Best fit from existing WARWIKI pages |
|---|---|
| Mild-to-moderate non-radiated SUI, residual sphincter function | Fixed sling or ATOMS depending severity and repositioning test |
| Moderate-to-severe SUI | AUS remains the reference standard; ATOMS is the main adjustable alternative |
| Failed AdVance / fixed sling | ATOMS has the strongest salvage data |
| Patient wants a minimally invasive adjustable option and is non-radiated | ProACT may be considered, with durability counseling |
| Prior pelvic radiation | AUS is usually favored; ATOMS is the main non-AUS adjustable option, with lower success than non-radiated cohorts |
High-Yield Differences
- ATOMS is the current adjustable sling workhorse in many non-US settings: transobturator, ventral compression, office port adjustment, and better comparative data than ProACT or REMEEX.
- Argus is historically important but has the highest complication burden in this group, including urethral erosion and pain.
- REMEEX has the most elegant re-tensioning mechanism, but retropubic passage creates bladder and bowel-injury risk.
- ProACT is not a sling. It is a periurethral balloon system at the bladder neck, best kept to carefully selected non-radiated mild-to-moderate cases.
Launch Note
This page is intentionally a hub. The device-specific pages carry the details and references; duplicating every outcome table here would create drift.