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

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.

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.

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<.0001 compared with baseline). SUI disappeared (81.7%) or remained mild (11.7%), moderate (5%) or severe (1.6%). We observed a reduction in the ICIQ-SF (p<.0001) and IIQ-7 scores (p=.0003). Both continence (p=.002) and satisfaction (p=.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).

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.

Actas urologicas espanolas. 2018 Apr 08 [Epub ahead of print]

C Esquinas, I Arance, J Pamplona, A Moraga, J F Dorado, J C Angulo

Servicio de Urología, Hospital Universitario de Getafe, Madrid, España., Servicio de Urología, Hospital Universitario de Getafe, Madrid, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España., Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España., Pertica S.L., Getafe, Madrid, España., Servicio de Urología, Hospital Universitario de Getafe, Madrid, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España. Electronic address: .