title: Five-year experience with the adjustable transobturator male system for the treatment of male stress urinary incontinence: a single-center evaluation.
abstract: BACKGROUND
  We report on our 5-year experience with the adjustable transobturator male system (ATOMS®,A.M.I., Feldkirch, Austria).
  
  
  METHODS
  Between 10-2009 and 10-2014, 54 patients received an ATOMS. The mean follow-up of this retrospective observational trial was 27.5 ± 18.4 (2.3-59) months. Within each follow-up, the following were evaluated: micturition protocol, 24-h pad count, uroflowmetry and residual volume. Statistical analysis was performed with SigmaPlot®11.0, p < 0.05 considered as significant.
  
  
  RESULTS
  Stress urinary incontinence (SUI) I°, II° and III° was seen in 1 (1.9 %), 16 (29.6 %) and 37 patients (68.5 %), respectively. In summary, 48.1 % of the patients became "dry" (0-"safty pad"/day), while 29.6 % achieved at least an "improvement" of about more than 50 % (1-2 pads/day), which corresponds to an overall success rate of 77.7 %. The mean number of pads/day decreased from 7.7 to 1.6. Regarding the initial degree of SUI, patients with mild or moderate incontinence had a significantly better outcome (p = 0.002, 95 % CI 0.9066 to 2.760). Postoperative complications were scaled according to the Clavien classification, in which we have seen 4 grade I-, 1 grade IIIa- and 9 grade IIIb-complications (overall 25.9 %). The evaluation of quality of life by ICIQ-SF showed a significant improvement (p = 0.0001, 95 % CI -14.56 to -11.75).
  
  
  CONCLUSIONS
  The treatment of male SUI using the ATOMS incontinence system achieved the best results in patients with mild and moderate incontinence. For severe incontinent patients, the system represents an efficient alternative.
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany. sandra.muehlstaedt@uk-halle.de.
authors.forename: Sandra
authors.initials: S
authors.lastname: Mühlstädt
authors.affiliation: Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Friedl
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
authors.forename: Nasreldin
authors.initials: N
authors.lastname: Mohammed
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
authors.forename: André
authors.initials: A
authors.lastname: Schumann
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Weigand
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Kawan
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Göllert
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
authors.forename: Christin
authors.initials: C
authors.lastname: Kahlert
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
authors.forename: Gerit
authors.initials: G
authors.lastname: Theil
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
authors.forename: Kersten
authors.initials: K
authors.lastname: Fischer
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fornara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D019736:Prostheses and Implants; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male
keywords: ATOMS; Adjustability; Artificial implants; Male stress urinary incontinence; Sphincter cushions