Abstract
Introduction
The ongoing rise in prostate cancer rates and consequent prostatectomy have led to an increase in rates of male stress urinary incontinence. ATOMS is an adjustable sling requiring no manual input and suitable for frailer patients. We investigated the long term efficacy of the ATOMs in managing SUI and performed a subanalysis within the geriatric population (aged 75+).
Method
69 men (mean: 70.2, range 50-81) underwent an ATOMS insertion between 2015-2019. Follow up data for up to 9 years were analysed (mean: 5.8, range 5-9 years). Out of the 69 men in the original cohort, 19 were aged 75+ (mean: 76.5, range: 75-81). 17 had SUI post radical prostatectomy, 1 post TURP and 1 post AP resection.
Results
Out of the 19 men, 14 (74%) were dry post ATOMs implant insertion (ie using maximum one pad per day for reassurance). This rate is lower compared with the original cohort (79.7%). The average number of top ups to achieve dryness was 3 (same as the initial cohort). Out of the 14 men who remained incontinent in the initial cohort, 5 were 75+. Of these, 2 reported a significant improvement in their incontinence without meeting the ‘dry’ criteria. 1 had his ATOMs device removed due to infection. 1 was switched to an artificial urinary sphincter. 1 remains incontinent and is being managed with botox injections. There were no cases of mechanical failure.
Conclusions
ATOMS appears to be an efficacious and safe procedure in the geriatric population, with only marginal difference in dry rates compared to the non-geriatric cohort. The main benefit over an artificial sphincter is that it exerts a passive effect to prevent incontinence and requires no patient input for every void. This is especially prudent as geriatric patients may lose hand dexterity or cognitive ability over time.