Adjustable transobturator male system – ATOMS – for the treatment of post-prostatectomy urinary incontinence: The surgical technique

OBJECTIVE. To present and evaluate initial perioperative experience with a new surgical treatment for post-prostatectomy urinary incontinence. Method: Between May 2008 and December 2010, an adjustable, hydraulic substitute sphincter system (ATOMS) was implanted in a series of 120 patients. In 105 of these 120 procedures, implantation was carried out using an outside-in technique. Adjustments via the port were made intraoperatively, and again no earlier than 3 weeks postoperatively if required. Results: The median operating time, including the learning curve, was 36 minutes. There were no severe intraoperative or perioperative complications. The most common postoperative side effects were temporary perineal/scrotal dysaesthesia or pain (62% of patients), which were controlled with non-opiate painkillers and subsequently abated. Four port infections in the first 28 patients led to a change in sterile conditions, no further infections occurred. Re-operation after failure of other devices was carried out in 43% of the patients and was successful in all cases. Conclusions: The system is a safe form of therapy for post-prostatectomy incontinence, and is suitable for a wide range of patients. We believe that such implants, with the option of minimally-invasive adjustment any time from 3 weeks postoperative onwards, will play an increasingly important role in incontinence surgery in the future.