The Adjustable Transobturator Male System in Stress Urinary Incontinence after Transurethral Resection of the Prostate: Beyond the Abstract

Transurethral resection of the prostate (TURP) is a cornerstone in surgical treatment of bothersome prostate enlargement and obstructive voiding disorders. It is also an option in patients after radiotherapy due to prostate cancer to relieve lower urinary tract symptoms. Lasting postoperative stress urinary incontinence is a rare side effect of this procedure but has a deep impact on patients’ daily life and social behavior.

Following failed conservative therapy options (e.g. pelvic floor muscle training, life style changes, weight loss) invasive therapies have received little attention in literature. We therefore carried out the first trial on the efficacy and safety of the adjustable transobturator male system (ATOMS) in patients suffering from stress urinary incontinence (SUI) caused by TURP. The ATOMS device so far has been implanted mainly in patients with post-radical prostatectomy incontinence. It is now in its third generation with a pre-attached full silicon covered scrotal port system and is therefore very easy to insert. The central silicon cushion which is placed directly onto the bulbospongious muscle is able to support the impaired sphincter region and can easily be adjusted in the outpatient setting without anesthesia. The ATOMS device is anchored around the obturator foramina which prevents dislocation.

In this large international ATOMS case series with an follow-up period of up to 34 months an overall continence improvement of 90% and a dry rate of 58% was achieved. Quality of life ratings changed vastly and patient global impression of improvement reached „high satisfaction level“. Patients who additionally had radiotherapie in their history (palliative TURP) had clearly inferior outcomes and higher removal rates compared to those without. Device removal is uncommon over time with infection beeing the prevalent reason.

Overall, the ATOMS device should be recommended in patients with persistent SUI after TURP and failed conservative treatment strategies. 

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Written By: Alexander Friedl, MD
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