First experience with ATOMS system implant in neurogenic stress urinary incontinence

Abstract

Aim To evaluate efficacy and safety of ATOMS implant in neurogenic patients with stress incontinence performing clean intermittent catheterization (CIC). Methods We included all patients with neurogenic sacral/subsacral lesion and stress urinary incontinence, treated with ATOMS implant between January 2018 and March 2019. All patients received anamnesis, 24‐hour pad test and pad count, physical examination, video urodynamic evaluation, Qualiveen questionnaire. All patients were followed up at 12 months after implantation. Patients were considered “continent” when dry or when wearing a security pad (social continence). Results We treated eight male patients with a median age of 25 years, four affected by myelomeningocele, and four by cauda equine syndrome. The median preoperative 24‐hour pad test was 225 g (interquartile range [IQR]: 180‐275). During the surgical procedure, we did not fill the cushion to prevent postoperative urethral injuries when performing CIC in the early postoperative time. At a 12‐month follow‐up, we had a significant reduction in postoperative 24‐hour pad test (median value: 7.5 g; IQR: 0‐16.25; P < .05). All patients reached continence. We had a significant reduction in the Qualiveen scores (P < .05). Patients demonstrated to be satisfied with the results of the intervention at the PGI‐I questionnaire. The only complications were four cases of temporary scrotal edema (Clavien‐Dindo 1) treated with conservative therapy. All patients resumed CIC without urethral traumatism nor catheter insertion difficulties. We had no cases of device infection nor device removal. Conclusions Implantation of ATOMS device seems to be an effective and safe minimally invasive procedure also in neurological patients with a low rate of postoperative complications.

Comparison Study between Artificial Urinary Sphincter and Adjustable Male Sling: A Propensity-Score-Matched Analysis

“…Indeed, patients with an increased risk of urethral injuries, such as patients who perform intermittent self-catheterization (ISC), are not suitable for the bulbar AUS; therefore, the ATOMS TM can represent a valuable alternative. Indeed, the use of the ATOMS TM device in patients with neurogenic bladders has already been carried out in a recent pilot study by Ammirati et al, which confirmed the safety of this device in this category of patients [14]. Indeed, port revision is the most frequently required reiterated procedure after ATOMS TM implantation, and this does not systematically require the explantation of the prosthesis, since the mere displacement of the port without infection can be managed conservatively even with an increased risk of infection and re-extrusion [11].…”