Presentation Authors: BOB YANG*, CLARE JELLEY, Steve Foley, READING, United Kingdom
Introduction: Male Stress Urinary Incontinence (SUI) is a debilitating condition, resulting often from radical prostatectomies. Current treatments include bulking agents, urethral slings and artificial sphincters. However efficacy is inconsistent, especially in severe incontinence where bulking agents and conventional slings fail. Furthermore artificial sphincters involve major surgery._x000D_
ATOMS (A.M.I., Austria) is a new adjustable sling consisting of a balloon mechanism inflated via a buried port-catheter allowing ongoing pressure adjustments in an outpatient setting, without needing anaesthetics._x000D_
We present the first experience in the United Kingdom of using ATOMS in treating men who developed SUI post prostate surgery, including patients who have failed previous conventional SUI surgical treatment.
Methods: Since 2015, 40 men (average age 70.4, range 50 - 81) with SUI post-surgery underwent insertion of ATOMS under general anaesthetic. _x000D_
37 (93%) developed stress incontinence following radical prostatectomy._x000D_
Follow-up was for up to 3 years (average - 17 months) via a specialist clinic.
Results: 34/40 (85%) post ATOMS were dry (defined as using up to a maximum of one pad for reassurance only). 22/40 (55%) achieved dryness within 6 months (range 1 - 24 months). _x000D_
15 (44%) of these newly dry patients had previously failed other surgical incontinence treatments (Urethral Bulking agents, Trans-obturator Tapes). _x000D_
Average pad use (per day) decreased from 3.2 to 0.6._x000D_
18/34 (53%) of patients achieved dryness without needing any top-ups. 5 required 1 top up. 5 required 2 top ups. 6 required 4 top ups._x000D_
5/6 (83%) of the &[Prime]non-dry&[Prime] patients had previously received radiotherapy. However ATOMS still reduced pad usage by 72% in these post-radiotherapy patients._x000D_
Average pain levels 2-3 weeks post-op was 2.5 out of 10. This decreased to 0.5 out of 10 by 6-8 weeks._x000D_
Complications were as follows: 2 patients developed superficial infections requiring antibiotics alone. 1 had erosion of inflator mechanism requiring reinsertion under general anaesthetics. 1 developed perineal pain requiring balloon deflation.
Conclusions: ATOMS is a novel safe and effective treatment for men with SUI post surgery, including radical prostatectomy, and also in patients where other surgical therapies have failed. _x000D_
Its&[prime] efficacy is hindered by previous radiotherapy, but is still successful at reducing overall pad usage._x000D_
Further studies on ATOMS in larger groups of patients with longer follow-ups are required to confirm these positive outcomes.