When conservative management fails, male patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical, and less invasive surgical techniques, such as the MRS-II® device (male regulating system), have been developed. 
The aims of the study are: 
-	To analyse objective effectiveness of the MRS-II® system in the treatment of male stress urinary incontinence. 
-	To assess the need for readjustment of the MRS-II® in male SUI patients. 
-	To study the survival and complication rates of the MRS-II® in male SUI patients.

Prospective observational study of 47 male patients with urinary incontinence after prostatic surgery and/or radiotherapy who received a MRS-II® device between July 2015 and May 2020. 
Patients were divided in three groups according to incontinence severity before surgery:
-	Group A (n=7; GA) patients with mild SUI (1-2 pads per day). 
-	Group B (n=22; GB) patients with moderate SUI (3-4 pads per day). 
-	Group C (n=18; GC) patients with severe SUI (≥5 pads per day). 
Effectiveness was assessed by the number of patients achieving complete (patients using no pad or 1 security pad) and partial (>50% reduction in the number of pads used) dryness. 
Results were analysed using descriptive statistics, Student’s t-test. Chi-square, Fisher’s exact test, ANOVA, and multivariate analysis. Significance was set at p<0.05.

Mean age was 69.76 years (range 58-80), with a mean follow-up of 33.52 months. 
Previous treatments: 29.79% of patients received radiotherapy, 65.96% open radical prostatectomy, 25.53% laparoscopic radical prostatectomy, 8.51% transurethral resection of the prostate (TURP); 23.41% had previous anti-SUI surgical treatment (19.15% AdVance®, 4.26% ATOMS®).
Objective effectiveness was observed in 89.36% of patients: 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among study groups (p=1.0000; Chi-square=0.158) (Figure 1). Patients with a history of radiotherapy had an 85.71% effectiveness compared to those without radiotherapy with 90.91% (p=0.0001).
34.04% of patients with an implant required at least one readjustment, without significant differences among groups (p=0.113; Chi-square=4.352). One readjustment was need in 17.02% of patients, 2 readjustments in 14.89%, and three readjustments in 2.13%. GC was the group with the highest readjustment rate with 44.44%, as opposed to 42.86% in GA and 22.73% in GB.
95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. Bladder perforation during the insertion of the retropubic needles happened in 5 patients (10.64%): in these cases, needles were removed and reinserted to finish the implantation of the device. Postoperative complications occurred in 3 patients (6.38%): one patient in GB reported perineal pain; one patient in GA required device removal of the system due to an infection; one patient in GB with a history of radical prostatectomy and radiotherapy developed urinary retention and bilateral vesicoureteral reflux after MRS-II® implant and required device removal.

In our study, we can find that the rate of completely dry patients (72.34%) is higher than the rate reported in previous studies (36-64.7%) (1-2). This could be explained because, as years go by, the surgical procedure has been further standardised, allowing for better results. This could also explain the lower percentage of patients who required one or more readjustments (34.04% in our study) as opposed to previous studies where the rate varied between 60% and 91% (1-2). A tendency towards less need of postoperative adjustments has already been reported and has been thought to be because of device’s improvement (3), but also the standardisation of the technique and of the postoperative regulation may play a role.

MRS® is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one third of cases.

Kim, S.W., et al., Male Readjustable Sling (MRS) System for Postprostatectomy Incontinence: Experiences of 2 Centers. Urology, 2016. 88: p. 195-200
Leizour, B., et al., [Adjustable retropubic suburethral sling Remeex((R)) in the treatment of male stress urinary incontinence: One-year results]. Prog Urol, 2017. 27(4): p. 238-243
Navalón-Monllor V, Ordoño-Domínguez F, Pallás-Costa Y, Vilar-Castro LA, Monllor-Peidro ME, Juan-Escudero J, Navalón-Verdejo P. Long-term follow-up for the treatment of male urinary incontinence with the Remeex system. Actas Urol Esp. 2016 Nov;40(9):585-591. doi: 10.1016/j.acuro.2016.03.009.