Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: results of a single centre

Abstract

Purpose: The aim of our study is to evaluate the efficacy and safety of ATOMS ® system for the treatment of postoperative male stress urinary incontinence (SUI). Materials and methods: We retrospectively evaluated all patients treated at our institution for postoperative male SUI with ATOMS ® implant. We excluded patients with low bladder compliance (< 20 mL / cmH 2 O), uncontrolled detrusor overactivity, detrusor underactivity (BCI < 100), urethral or bladder neck stricture and low cystometric capacity (< 200 mL). Results: From October 2014 to July 2017 we treated 52 patients, mean age 73.6 years. Most of them (92.3%) had undergone radical prostatectomy, 3.85% simple open prostatectomy, 3.85% TURP; 28.8% of patients had undergone urethral surgery, 11.5% adjuvant radiotherapy; 57.7% had already undergone surgical treatment for urinary incontinence. The average24 hours pad test was 411.6 g (180 – 1100). The mean follow-up was 20.1 months (8.1 – 41.5) 30.8% of patients were dry, 59.6% improved ≥ 50%, 7.7% improved < 50% and 1.9% unchanged. In total 73.1% reached social continence. There was a significant reduction of the 24 hours pad test and ICIQ - UI SF scores (p < 0.01). In the postoperative follow-up we detected complications in 8 patients (19%): 5 cases of displacement of the scrotal port, in 2 cases catheterization difficulties, one case of epididimitis and concomitant superficial wound infection; no prosthesis infection, nor explants. Radiotherapy, previous urethral surgery,previous incontinence surgery were not statistically related to social continence rates (p 0.65;p 0.11;p 0.11). Conclusions: The ATOMS ® system is an effective and safe surgical treatment of mild and moderate male postoperative SUI with durable results in the short term.

First experience with ATOMS system implant in neurogenic stress urinary incontinence

“…The severity of incontinence in our population is mild to moderate. Continence results are comparable with those of a previous study on the implant of ATOMS system for the treatment of postprostatectomy SUI (mild incontinence: 100% dry; moderate incontinence: 75%; social continence: 87.5%; substantial benefit >50%) 5 …”

“…All patients were implanted with the ATOMS system by a single surgeon, following the same standardized surgical technique 5 . The only difference was that during the surgical procedure we did not fill the cushion to prevent postoperative urethral injuries when performing CIC in the early postoperative time.…”

Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and Adjustable Continence Therapy (ProACT) for male stress incontinence

“…Also it is not so minimally invasive procedure as the complication rate, both total and major complications, surmounts that of ATOMS implant. A very recent experience uses ATOMS after retrieval of ProACT and indirectly supports ATOMS is superior to ProACT in the short-term [51]. What is more ATOMS can be used after radiation while ProACT is not recommended in this situation [6,31].…”

Artificial Urinary Sphincter for Postradical Prostatectomy Urinary Incontinence — Is It the Best Option?

“…The lack of urethral erosion, and minimal infective problems, make ATOMS an excellent alternative for conditions with former treatment failure. The most recent results for ATOMS, after a mean follow-up of 22.1 months, demonstrated that 30.8% of patients recovered continence thoroughly, and 59.6% of patients had diminished urinary losses of > 50%; thus, a total 73.1% of patients attained social continence [32]. This operation seems to be inventive and has several exclusive aspects: i.e., outpatient adjustment and a single-incision transobturator method.…”