Stress urinary incontinence is a devastating complication after radical prostatectomy. Original suburethral slings are ineffective and cannot be easily adjusted after insertion. Artificial urinary sphincters require good patient dexterity and cognitive function, additionally, the surgery is invasive. Adjustable Transobturator Male System (ATOMS) Agency for Medical Innovations (A.M.I., Austria) is an adjustable sub-urethral device consisting of a balloon mechanism inflated via a buried port catheter. This port-catheter allows for insufflation alterations to the balloon in an outpatient setting without requiring anaesthesia. 

We present the first UK experience of using ATOMS in treating men with stress urinary incontinence.

Between 2015 and 2019, 70 men (average age 70.3, range 50 to 81 years) underwent insertion of ATOMS for post-surgical stress urinary incontinence. Of these, 66 (94%) had stress urinary incontinence secondary to radical prostatectomy. 11 (16%) had previously had a conventional sling and 14 (20%) had previously had urethral bulking agents. The average follow-up was 4 years (range 2 to 6).

54/70 (77%) men were dry after ATOMS insertion. Dryness was defined as using a maximum of one pad a day, for reassurance only. Dryness was achieved within 6 months for 34/54 (63%), (range 1 to 24 months). The average pad use was 3.3 pre-operative and 0.7 post-operative. Of the men that did not achieve dryness, 7/14 (50%) had previously undergone radiotherapy. The average pain score at three weeks post-operative was 2.5/10. This decreased to 0.5/10 by eight weeks. 

There were 11 (16%) complications: 2 cases of urinary retention, 2 cases of mild perineal pain, 2 cases of mild scrotal pain, 1 case of balloon mechanism erosion requiring re-implantation, 1 case of balloon mechanism require repositioning, 1 case of a superficial wound infection treated medically and 2 cases of infected device requiring removal.

The ATOMS is an efficacious treatment for men with stress urinary incontinence. The time to achieve dryness reflects the post-operative incremental adjustments to balloon volume. The effectiveness of the ATOMS appears to be hindered by previous radiotherapy. The ATOMS device has low complication rates with only two cases requiring removal.

The ATOMS device has a high success rate in men with stress incontinence post-prostatectomy. From our studies to date, the ATOMS seems to be less effective in men that have previously received radiotherapy.

Further reviews on ATOMS with larger numbers of patients and longer follow-ups are required. In particular, randomized control trials should be established in order to confirm these positive outcomes and ascertain the long-term safety profile of the ATOMS device.