The condition of stress urinary incontinence in men is debilitating and often occurs as the result of radical prostatectomy. Slings can be difficult to adjust post-operatively or over time and are ineffective when incontinence is severe. Artificial sphincters require more involved surgery.

The ATOMS (A.M.I., Austria) sling has a balloon mechanism inflated via a buried catheter, allowing ongoing pressure adjustments to be made in an outpatient setting, with no anesthesia required.

Our report presents the first five-year experience of using ATOMS to treat men with SUI in the UK.

In the period from 2015 to 2021, 71 men (average age 70.3 years, range 50 to 81 years) were recruited and followed up. Of these, 67 men (94%) had stress urinary incontinence as a result of a radical prostatectomy, and 16 (23%) had prior radiotherapy post-prostatectomy.

In 70 men, ATOMS® was inserted under general anesthesia. In 1 patient, due to his underlying morbid obesity, ATOMS could not be inserted and he was therefore excluded from the study. Follow up lasted up to 6 years (mean: 4 years; range: 2 - 6 years).

Men were dry in 53/70 (76%) cases after insertion of ATOMS (defined as using one pad a day only for reassurance). Dryness was achieved in 34/53 cases within 6 months (range, one to 24 months). The average pad use was 3.4 preoperatively and 0.7 postoperatively. 

Of the 17 patients who were not deemed “dry” post ATOMS insertion and therefore a treatment failure, overall pad usage decreased by 51% in this group. The average pad usage in patients who failed ATOMS treatment was 3.9 (range: 2 - 6) whilst post ATOMS insertion, despite being classified as treatment failure, average pad usage dropped to 1.9 (range: 1 – 4).

7 of 17 men (41%) who were unable to achieve dryness had previously undergone radiation therapy.

The following 11 (16%) complications occurred: two cases of infected devices requiring removal, one case of balloon mechanism erosion requiring re-implantation, one case of balloon mechanism repositioning, four cases of persistent perineal or scrotal pain, two cases of urinary retention, and one case of a superficial wound infection treated medically. 

Overall 5 devices with removed.

For men with SUI, ATOMS appears to be a safe and effective treatment. ATOMS is unique in that it can be adjusted in the post-operative period and that patients can urinate without manipulating the device itself. In addition, its relative simplicity makes it less prone to error and device failure. Moreover, the vast majority of patients (91%) reported a drop in daily pad use post ATOMS, and even those patients who were not able to regain continence had an improvement in their overall quality of life that prevented them from seeking future alternative treatment, such as an AUS.

In this study, results have been shown for the first use of ATOMS in the United Kingdom, demonstrating efficacious results for SUI with longevity of up to 6 years. 

However, this study was conducted by a single centre and with an uncontrolled cohort. Therefore future studies involving larger cohorts with longer follow-ups and incorporating validated ICIQ-UI SF questionnaire assessments are required.