Adjustable Transobturator Effectively Treats Male Incontinence

The adjustable transobturator male system (ATOMS) is a long-term, adjustable implant designed to treat male SUI, generally following invasive treatment of the prostate gland. The implant is based on a suburethral substitute sphincter cushion that provides a gentle, evenly distributed pressure on the bulbospongiosus muscle in order to reduce the risk of urethral erosion. There is no specific point of maximum compression on the urethra, and patients can urinate freely, without having to activate a mechanical component.

The cushion is located in the middle of a mesh fixation tape, with integrated mesh arms that are drawn back around to the middle of the implant and over the inferior pubic ramus to secure the system in place, providing 4-point-fixation that eliminates the need for fasteners or screws. The macroporous mesh integrates into the bone, leading to an extra firm hold. Tissue ingrowth and revascularization of the surrounding tissue reduce the risk of an infection spreading in the pelvis operatively or post-operatively.

Following placement, the substitute sphincter cushion is filled via a scrotal port-catheter connection; the patient-specific adjustments require no further surgical intervention, and can be made at any time to counteract either continuing incontinence or urinary retention. From then on, the ATOMS cushion exerts gentle compression pressure on the bulbospongiosus muscle, and thus indirectly of the urethra, increasing urethral resistance. Involuntary loss of urine is thus reduced or ideally avoided. The ATOMS device is a product of the Agency for Medical Innovations (AMI; Feldkirch, Austria).

“The ATOMS device is safe and shows high treatment efficacy and patient satisfaction in the largest cohort study to date,” said Alexander Friedl, MD, of Hospital Göttlicher Heiland (Vienna, Austria), who led a recent international study of the device. “The latest generation, with its pre-attached silicone-covered scrotal port, is superior to its predecessors. Significantly better results were achieved with primary implantation and in those without a history of radiotherapy.”

In men, SUI usually results from a procedure to remove an enlarged prostate that causes difficulty in urinating. The resulting surgical damage to the urinary sphincter leads to incontinence, or creates functional problems. When the strength of the sphincter muscle is compromised, urine may leak through the urethra. Under pressure to the bladder, such as with a golf swing or a sneeze, leakage may be slight. However, depending on the severity of damage, the impaired sphincter could allow a steady stream of urine.

Related Links:
Agency for Medical Innovations
Hospital Göttlicher Heiland