title: Sexuality and erectile function after implantation of an Adjustable Transobturator Male System (ATOMS) for urinary stress incontinence. A multi-institutional prospective study.
abstract: OBJECTIVE
  To investigate erectile function and sexuality before/after implantation of the ATOMS device including continence outcome, pain perception and co-morbidities.
  
  
  METHODS
  We collected data from 34 patients (2010-2014) who were provided with an ATOMS implant due to mild or moderate stress urinary incontinence (SUI) after radical prostatectomy (RPE), transurethral resection (TURP) or radiotherapy. Previous failed implants were no contraindication. Sexuality was evaluated with the International Index of Erectile Function (IIEF-5). The Visual Analog Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used to analyse pain perception. Results regarding continence, influence of co-morbidities and drug intake were interpreted.
  
  
  RESULTS
  IIEF-5 score increased 6 months after ATOMS implantation with a mean difference of 2.18 (Cl: 1.22, 3.14), p &lt; 0,001). Non-sexually active patients had the greatest benefit. However, 50% of patients achieved a mean IIEF-5 of 10.1 and 38% of patients reported a new onset of sexual activity at follow up (mean IIEF-5 score of 12.9). This is in accordance with reduced SUI and absence of persistent pain syndrome. Overall success rate regarding 24h pad-use was 88% (no pad rate 38%). Previous failed implants did not influence results but diabetes, obesity and drug intake (beta-blockers, antidepressants) led to poorer outcomes.
  
  
  CONCLUSIONS
  Sexuality and erectile function improves significantly 6 months after ATOMS implantation. We postulate that reduced SUI (also during sexual activity) and absence of chronic pain are the improving factors. ATOMS should be offered to men with mild to moderate SUI who are interested in regaining their erectile function and sexual activity.
authors.affiliation: Department of Urology, Hospital Göttlicher Heiland, Vienna. alexander.friedl@khgh.at.
authors.forename: Alexander
authors.initials: A
authors.lastname: Friedl
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Bauer
authors.forename: Maximilian
authors.initials: M
authors.lastname: Rom
authors.forename: Danijel
authors.initials: D
authors.lastname: Kivaranovic
authors.forename: Werner
authors.initials: W
authors.lastname: Lüftenegger
authors.forename: Clemens
authors.initials: C
authors.lastname: Brössner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010410:Penile Erection; D015917:Penile Prosthesis; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D019529:Sexuality / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*