Treatment of male stress urinary incontinence with the Adjustable Transobturator Male System (ATOMS): The Australasian Experience
Dr. Jordan Mann (1), Mr. Andre Westenberg (1)
(1) Bay Of Plenty District Health Board, Tauranga, New Zealand
Male stress urinary incontinence (SUI) is a significant problem with an immense impact on quality of life. Surgical treatment options include bulking injections, artificial urinary sphincters, and male slings. The aim of this study was to describe our experience and present functional and safety outcomes for a novel adjustable sling for the management of male SUI.
We performed a retrospective analysis of consecutive men that underwent ATOMS sling insertion for SUI in a single centre in New Zealand between May 2015 and March 2018. The primary outcomes of the study were twofold – reduction in the number of pads used over a 24-hour period, and the development of Clavien-Dindo (CD) complications.
A total of 65 patients with a mean age of 69.4 (range 53-85) were included in the study. The most common cause of SUI was radical prostatectomy (89%). Thirty-two percent had undergone prior unsuccessful continence procedures and 52% had salvage radiotherapy following their radical prostatectomy. Outcomes are shown in Table 1. There was a statistically significant decrease in mean 24-hour pad use pre- versus post-operatively (p < 0.00001).Twenty-two patients developed a CD grade 1-3 complication. The most frequent complication was perineal/scrotal pain requiring analgesia (n=14). All of these cases self-resolved within six weeks. Infection/port extrusion requiring surgical removal was the most common CD grade 3 complication occurring in four men.
Management of post-prostatectomy SUI with the ATOMS sling is safe and efficacious, with reasonable results even in this difficult patient group.