Original Article

Adjustable transobturator male system – ATOMS – for the treatment of post-prostatectomy urinary incontinence: The surgical technique


Pelviperineology 2011;30(1):10-16


To present and evaluate initial perioperative experience with a new surgical treatment for post-prostatectomy urinary incontinence.


Between May 2008 and December 2010, an adjustable, hydraulic substitute sphincter system (ATOMS) was implanted in a series of 120 patients. In 105 of these 120 procedures, implantation was carried out using an outside-in technique. Adjustments via the port were made intraoperatively, and again no earlier than 3 weeks postoperatively if required.


The median operating time, including the learning curve, was 36 minutes. There were no severe intraoperative or perioperative complications. The most common postoperative side effects were temporary perineal/scrotal dysaesthesia or pain (62% of patients), which were controlled with non-opiate painkillers and subsequently abated. Four port infections in the first 28 patients led to a change in sterile conditions, no further infections occurred. Re-operation after failure of other devices was carried out in 43% of the patients and was successful in all cases.


The system is a safe form of therapy for post-prostatectomy incontinence, and is suitable for a wide range of patients. We believe that such implants, with the option of minimally-invasive adjustment any time from 3 weeks postoperative onwards, will play an increasingly important role in incontinence surgery in the future.

Keywords: Prostatectomy; Urinary incontinence; Post prostatectomy incontinence; Artificial urinary sphincter; Sling