Adjustable Transobturator Male System (ATOMS) in Artificial Urinary Sphincter patients - a good Alternative?

INTRODUCTION: Post-prostatectomy stress urinary incontinence (SUI) significantly impairs patients' quality of life. While the artificial urinary sphincter (AUS) is considered the gold standard for managing severe SUI, a subset of patients is not suitable for this intervention. This study aimed to evaluate the clinical outcomes of patients who received an adjustable transobturator male system (ATOMS) as an alternative to AUS for the treatment of SUI. METHODS: In this single-center retrospective study, we included 25 patients who received ATOMS implantation for post-prostatectomy SUI, despite being technically eligible for AUS based on incontinence severity and pelvic floor status. Primary outcomes included pad usage, continence rates, complications, and patient-reported satisfaction. A cross-sectional follow-up was conducted in using standardized questionnaires. RESULTS: Median age was 74.0 years; 60% of patients had undergone pelvic radiotherapy. Preoperative median pad usage was 6.0/day, reduced to 3.0/day postoperatively. Social continence (≤1 pad/day) was achieved in 16%, and ≥50% reduction in pad usage in 76% of patients. Complications were mostly minor. Cross-sectional follow-up data were available for 60% of patients at a median of 42 months. Patient satisfaction was high (73.3%), and 80% would recommend the procedure. According to the PGI score, 73.3% reported "very much" or "much improved" outcomes. CONCLUSION: ATOMS represents a feasible and safe treatment alternative for patients with severe SUI who are unable or unwilling to undergo AUS implantation. Despite suboptimal continence outcomes compared to AUS, high satisfaction and acceptable complication rates support its use in appropriately selected patients.