title: Early results of a European multicentre experience with a new self-anchoring adjustable transobturator system for treatment of stress urinary incontinence in men.
abstract: OBJECTIVE
  To report our experience with a new self-anchoring adjustable transobturator male system (ATOMS®; AMI, Vienna, Austria) for the treatment of stress urinary incontinence (SUI) in men.
  
  
  METHODS
  A total of 99 men, in a number of centres, were treated for SUI with the new ATOMS® device. The device was implanted in all patients using an outside-in technique by passing the obturator foramen and anchoring the device to the inferior pubic ramus. The titanium port was placed s.c. on the left symphysis region. Adjustments were performed via port access. Postoperative evaluation consisted of physical examination, 24-h pad test, and 24 h-pad count. Preoperatively and at 6-month follow-up, patients completed a validated quality-of-life questionnaire. Two-way ANOVA was used to analyse changes over time. Within-group effects for time were tested using post hoc Dunnett's contrasts of baseline values vs subsequent measurements.
  
  
  RESULTS
  The most common indication was SUI after radical prostatectomy (92.9%). Failure of previous surgeries was present in 34.3% patients and 31.3% patients had undergone secondary radiation. The mean (SD; range) surgery time was 47 (13.8; 29-112) min. Temporary urinary retention occurred in two patients (2%) and transient perineal/scrotal dysaesthesia or pain was reported by 68 patients (68.7%) and resolved after 3-4 weeks of non-opioid analgesics. There were four (4%) cases of wound infection at the site of the titanium port leading to explantation. No urethral or bladder injuries related to the device or erosions occurred. The mean (SD; range) number of adjustments to reach the desired result (dryness, improvement and/or patient satisfaction) was 3.8 (1.3; 1-6). After a mean (SD; range) follow-up time of 17.8 (1.6; 12-33) months, the overall success rate was 92% and the mean pad use decreased from 7.1 to 1.3 pads/24 h (P < 0.001). Overall, 63% were considered dry and 29% were improved.
  
  
  CONCLUSIONS
  Treatment of male SUI with this self-anchored adjustable system is safe and effective.
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther-Medical School, Halle, Germany. rhoda@ucsd.edu
authors.forename: M Raschid
authors.initials: MR
authors.lastname: Hoda
authors.forename: Günter
authors.initials: G
authors.lastname: Primus
authors.forename: Katja
authors.initials: K
authors.lastname: Fischereder
authors.forename: Burkhard
authors.initials: B
authors.lastname: Von Heyden
authors.forename: Nasreldin
authors.initials: N
authors.lastname: Mohammed
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmid
authors.forename: Volker
authors.initials: V
authors.lastname: Moll
authors.forename: Amir
authors.initials: A
authors.lastname: Hamza
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Karsch
authors.forename: Clemens
authors.initials: C
authors.lastname: Brössner
authors.forename: Paolo
authors.initials: P
authors.lastname: Fornara
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Bauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects; D011474:Prosthesis Design; D011788:Quality of Life; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial