Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery

Area of Science:

• Urology
• Surgical Devices
• Incontinence Management

Background:

• Post-prostatectomy incontinence (PPI) is a common complication following prostate cancer treatment.
• The adjustable trans-obturator male system (ATOMS) is a surgical device designed to address PPI.
• The silicone-covered scrotal port (SSP) ATOMS is the current available generation of this device.

Purpose of the Study:

• To review the current literature on the SSP ATOMS.
• To assess the effectiveness, safety, and duration of the SSP ATOMS device.
• To compare SSP ATOMS outcomes with existing treatments for PPI.

Main Methods:

• A non-systematic literature review was conducted.
• Forty-eight full-text articles were assessed, with specific exclusion criteria applied.
• Thirty studies focusing on SSP ATOMS were included in a qualitative synthesis, and 10 were used for quantitative analysis of outcomes.

Main Results:

• Pooled data from 1515 patients showed high effectiveness: dry rates of 63-82% and improved rates of 85-100%.
• Complication rates ranged from 7-33%, with device infection at 2.7-6.2% and explant rates from 0-19%.
• The device demonstrated good durability, with 89% remaining in place after 5 years.

Conclusions:

• SSP ATOMS results appear equivalent to artificial urinary sphincters (AUSs) regarding continence, satisfaction, and complications.
• SSP ATOMS may offer a lower rate of long-term revision compared to AUSs.
• Patients with specific incontinence severity (pad test <900 mL, MSIGS not 4) are identified as optimal candidates.