Introduction: The ATOMS has recently gained popularity in the post-prostatectomy incontinence (PPI) scene, touting advantages such as surgical simplicity and post-operative adjustability. The present study explores the device as a potential treatment option for PPI. Primary outcome was dryness rate, 24-hour pad-count change compared to baseline and results from the patient global impression of improvement (PGI-I) questionnaire. Secondary outcome was the frequency of postoperative adverse events.
Methods: A retrospective medical record study was conducted on 91 patients who underwent ATOMS implantation between February 2016 and September 2020 at our institution. Preoperative incontinence severity was defined as <2 pads per day (PPD), 2-4 PPD, and >4 PPD with regards to 24-h pad-count or/and <200g, 200-400g and >400g regarding 24-h pad-test (24h-PT) to classify mild, moderate, and severe incontinence, respectively. Dryness was defined as requiring 0 or 1 PPD postoperatively. Patients considered “improved” or “very much improved” were defined as having a diminution of PPD of = 50% or = 75%, respectively. Positive patient satisfaction was defined by “Much better”, and “Very much better” PGI-I results.
Results: Out of the 91 patients identified, 65 were included in the study (26 were excluded due to a follow-up <12 months). Mean patient age was 71 years, with a mean follow-up of 29.9 months (SE 1.8; range 12-67). Median preoperative PPD and 24h-PT were 4 (IQR 6-3; range 1-10) and 358 g (IQR 607-256; range 34-1592) respectively, classifying most patients as moderate (n=24; 36.9%) or severe (n=40; 61.5%) incontinence. Median PPD at final follow-up was 1.0 (IQR 2-0; range 0-5; p < 0.001). 59 (90.7%) patients required adjustment postoperatively, with a mean of 2.4 adjustments (SE 0.25; range 1-8) and a mean total instilled volume of 14.8mL (SE 0.76; range 6-31). Overall improvement was noted in 56 (86.2%) patients, with 43 (76.7%) being “very much improved” and 42 (75.0%) being dry. Patient satisfaction rate was 87.7% (n=57). 8 (12.3%) patients experienced complications of any Clavien-Dindo grade, of which 4 were a grade III due to 1 device migration (1.5%), and 3 explantations due to leakage (4.6%).
Conclusions: The present study vouches ATOMS as a safe and effective device in the treatment of PPI. More robust studies may allow integration of the ATOMS device among treatments options in North American urological practices.
Source of Funding: Funding was acquired from the research budget of the Urology Department at Université de Sherbrooke.
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