Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: an Italian multicentric study.

Abstract

BACKGROUND The aim of this study is to evaluate efficacy and safety of the ATOMS system for the treatment of postoperative stress urinary incontinence (SUI). METHODS We included all consevutive male patients referring for postoperative SUI and treated with ATOMS system from June 2013 to July 2017. Patients received anamnesis, 24h pad test, pad count, physical examination, urodynamic evaluation, ICIQ-UI SF questionnaire. We excluded patients with low bladder capacity and compliance, uncontrolled detrusor overactivity. RESULTS We treated 98 patients with median age of 70.21 ± 10.02 years. The most common cause of SUI was open radical prostatectomy in 79 patients. Ten patients had undergone urethrotomy, 7 bladder neck incision, 14 adjuvant radiotherapy. Thirty-nine patients suffered of mild incontinence (24h pad test <200g), 49 moderate incontinence (200-400g), 10 severe incontinence (≥400g). 31 patients underwent previous incontinence surgery: 29 ProACT, 3 artificial urinary sphincter (in 2 cases both devices), 1 bulking agents and subsequent male sling. Median follow-up was 21.5 months. We had a significant reduction of mean 24h pads test, pad count and ICIQ-UI SF questionnaire (p<0.01). At last follow-up 47.96% of patients were dry and 79.59% reached social continence. A high incontinence grade, adjuvant radiotherapy, previous urethral surgery and incontinence surgery have been associated with lower continence results. We had complications in 33 patients (33.7%). The device was removed in 4 cases due to scrotal port erosion and in one case due to persistent pain. CONCLUSIONS The ATOMS system seems to be an effective and safe surgical treatment for postoperative male SUI.