Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS®) with preattached scrotal port

Abstract Introduction 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. Materials 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 analyzed 60 consecutive patients with a follow-up of 21 ± 22 months. The baseline pad-test was 465 ± 450 mL, 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 ± 25 min, the hospital stay was 1 ± 0 days, and the visual analog scale of pain on day 1 after surgery was 0 ± 1. The total filling was 16.5 ± 7 mL, and the number of refillings was 1 ± 2. The pad-test and pad-count after the adjustment were 0 ± 20 mL and 0 ± 1, respectively (both P P P  = 0.0003). Both continence ( P  =  0 .002) and satisfaction ( P  = 0.03) were lower in the irradiated patients. Complications occurred in 11 cases (18.6%), 8 (13.5%) of which were grade I and 3 (5.1%) of which were grade 3. The treatment satisfaction rate was 91.7%, and the patient-perceived overall improvement at 1 year was highly pronounced (PGI-I score, 1±1; GRA, 6±1). 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.