Adjustable Transobturator Male Sling (ATOMS) for Post-Prostatectomy Stress Urinary Incontinence

D. Carracedo, G. Belkahia, L. Esteban, M. D. Sánchez-Gallego, V. Viegas Madrid, C. Mínguez, T. Jerez-Izquierdo, G. Celada, C. Sánchez-Guerrero, J. Romero Otero

ATOMS; Male Incontinence; Radical Prostatectomy; Adjustable Sling; Bulbar Urethra

The video presents the surgical technique and clinical outcomes of the Adjustable Transobturator Male System (ATOMS) for the treatment of male stress urinary incontinence (SUI) following radical prostatectomy. A 69-year-old man with moderate post-prostatectomy SUI underwent ATOMS implantation after unsuccessful conservative therapy and urodynamic confirmation of sphincter competence.

Under general anesthesia, a 14 Ch Foley catheter was placed, and a midline perineal incision was performed. Layered dissection was carried out to expose and preserve the bulbospongiosus muscle, continuing parallel to the bulbar urethra until the crura were identified. Helical tunneling needles were advanced through the obturator foramina under tactile control, retrieving the tips bilaterally in the ischiorectal fossae. Guiding sutures facilitated the passage of the mesh arms, allowing symmetrical placement of the silicone cushion beneath the bulbar urethra. The system was purged with saline, leaving 8.5 mL in situ, and a titanium port was placed in the left hemiscrotum for future adjustments. Layered perineal closure was performed with absorbable sutures.

Operative time was 57 minutes with minimal blood loss. The patient was discharged 24 hours postoperatively and achieved full continence after two postoperative adjustments (final volume 11 mL). No intra- or postoperative complications occurred.

The ATOMS system represents a safe, effective, and adjustable alternative for the management of post-prostatectomy male SUI. Its minimally invasive implantation and postoperative adjustability allow individualized treatment and significant improvement in quality of life.

None.

The authors have nothing to disclose

1. EAU Guidelines. Urethral Incontinence in Men. European Association of Urology; 2024.

2. AUA Guidelines. Incontinence after Prostate Treatment. American Urological Association; 2023.

3. Friedl A, Mühlstädt S, Zachoval R, et al. Long-term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study. BJU Int. 2017;119(5):785-792. doi:10.1111/bju.13684.