Stress urinary incontinence (SUI) in men is a debilitating condition, often occurring after prostate cancer surgery, with an incidence ranging from 4% to 40%. Key predictors of SUI post-prostatectomy include age, body mass index (BMI), comorbidity index, lower urinary tract symptoms, catheter removal timing, surgical technique, and prostate volume. Prostatectomy is the largest cause of SUI, but it can also result from transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP). Patients’ outcomes post-radical prostatectomy are often measured by a ‘Trifecta’ of urinary continence, potency, and cancer control, with 73.9% achieving trifecta. These patients typically have smaller prostates and lower Gleason scores. The continence rate post-radical prostatectomy is around 90% at 12 months. Management of SUI includes conservative methods like pelvic floor physiotherapy and lifestyle modifications or surgical interventions such as transurethral injection of bulking agents, artificial urinary sphincters (AUS), and male slings. Although AUS offers the best continence rates (up to 86%), it involves invasive surgery, significant complications, and requires the patient’s manual dexterity for urination. The reoperation rate for AUS ranges from 18.1% to 24.0%. The Adjustable Transobturator Male System (ATOMS®) is a hydraulic urethral compressive device, adjustable postoperatively, providing an alternative to AUS. This study evaluates ATOMS’ effectiveness in treating male SUI in the UK between 2015 and 2021. Seventy-one men with post-surgical SUI were identified and followed. Diagnosis was confirmed via a five-day bladder diary, excluding those with concurrent bladder overactivity. ATOMS was inserted under general anaesthesia, with adjustments made postoperatively in outpatient settings. Seventy patients underwent ATOMS insertion, with follow-up up to six years (mean: four years). The average age was 70.3 years. Most patients (94%) had incontinence following radical prostatectomy. Sixteen patients had previous radiotherapy, one after abdomino-perineal resection, and three post-TURP. Fifty-three patients (76%) achieved dryness (using up to one pad per day), and 64 patients (91%) reduced pad usage post-ATOMS. Preoperatively, patients used an average of 3.4 pads per day, which dropped to 0.7 postoperatively. Within six months, 64% of patients achieved dryness. Effectiveness was higher in patients without prior radiotherapy, with an 82% reduction in pad usage compared to 67% in those with radiotherapy. The study reported complications in 16% of patients, with 7% requiring device removal due to pain or infection. Comparatively, AUS devices have higher rates of explantation due to device erosion or malfunction. ATOMS proved effective, with 76% achieving dryness and 91% reducing pad usage. Though AUS offers higher dryness rates, ATOMS’ adjustability and less invasive nature make it a viable option. Complication rates for ATOMS are lower than those for AUS. Future studies should include larger patient numbers, longer follow-ups, and use validated questionnaires like ICIQ-UI SF to assess patient-reported outcomes and quality of life. Overall, ATOMS offers a promising alternative for SUI management, especially for patients who may struggle with the manual operation of AUS. The study’s results support further investigation into ATOMS, particularly through randomised control trials to validate its long-term efficacy and safety.
Adjustable Transobturator Male System® as a novel treatment for men with stress urinary incontinence
Reviewed by Asif H Ansari
Adjustable Transobturator Male System® (ATOMS) as a novel treatment for men with stress urinary incontinence in the United Kingdom.
