Tratamiento de la incontinencia urinaria de esfuerzo tras prostatectomía con el sistema masculino transobturador ajustable (ATOMS®) con puerto escrotal premontado

espanolIntroduccion La incontinencia urinaria de esfuerzo (IUE) es una secuela importante del tratamiento quirurgico del cancer de prostata. Se presenta la tecnica quirurgica y se evalua efectividad y seguridad del sistema masculino transobturador ajustable (ATOMS®) con puerto escrotal premontado. Material y metodo Estudio abierto prospectivo realizado en un hospital universitario. El objetivo principal fue cambio de situacion basal tras ajuste en el recuento diario de compresas (pad-count) y su peso humedo (pad-test). Los objetivos secundarios fueron evaluacion de calidad de vida (ICIQ-SF e IIQ-7 basal y al ajuste), resultados percibidos por el paciente (PGI y GRA al ano) y evaluacion de complicaciones segun Clavien-Dindo. Los valores numericos se expresan en mediana + RIC. Resultados Se analizan 60 pacientes consecutivos con seguimiento de 21+22meses. El pad-test basal fue 465+450ml y pad-count 5+3 compresas/dia. La IUE basal fue leve (11,6%), moderada (25%) y severa (63,3%). El tiempo operatorio fue 60+25min, la estancia hospitalaria 1+0 dias y la EVA de dolor en dia-1 postoperatorio 0+1. El llenado total fue 16,5+7ml y el numero de rellenos 1+2. Pad-test y pad-count tras ajuste fueron 0+20ml y 0+1, respectivamente (ambos p Conclusiones El tratamiento de la IUE masculina con ATOMS® tercera generacion es seguro y eficaz a corto plazo, incluso en pacientes con IUE severa. La tasa de pacientes secos tras el ajuste supera el 80% y la tasa de satisfaccion el 90%. Los pacientes valoran muy positivamente este tratamiento. EnglishIntroduction Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS®) with preattached scrotal port. Material and method An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. Results We analysed 60 consecutive patients with a follow-up of 21±22 months. The baseline pad-test was 465±450mL, and the pad-count was 5+3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60±25min, the hospital stay was 1±0 days, and the visual analogue scale of pain on day 1 after surgery was 0±1. The total filling was 16.5±7mL, and the number of refillings was 1±2. The pad-test and pad-count after the adjustment were 0±20mL and 0±1, respectively (both p Conclusions SUI treatment of men using third-generation ATOMS® is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively.