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First experience with the ATOMS(®) implant, a new treatment option for male urinary incontinence.

González SP, Cansino JR, Portilla MA, Rodriguez SC, Hidalgo L, De la Peña J - Cent European J Urol (2014)

Bottom Line: Three patients experienced perineal-scrotal dysesthesias that disappeared spontaneously in the first three months.The described adjustable continence system has been found to be very effective in males with mild to moderate UI.In our experience, the ATOMS(®) implant offers excellent results over the middle term with a very low rate of complications that were easily resolved in all cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hospital Universitario La Paz, Madrid, Spain.

ABSTRACT

Introduction: Urinary incontinence (UI) is defined as any complaint of involuntary urine leakage. A description is provided of our experience with the ATOMS(®) (Adjustable Transobturator Male System. Agency for Medical Innovations. A.M.I.) adjustable implant in patients with mild to moderate UI.

Material and methods: A retrospective study was made of the data referring to 13 patients treated with this adjustable system. Demographic and personal data were collected along with information on the etiology, severity, characteristics, duration of UI, complementary tests, surgery times, complications and results obtained.

Results: The full continence (no use of pad) recovery rate at the close of the study was 12/13 (92.3%). Three cases required a single filling during the mean 16 months of follow-up (range 4-32; median 14 months). A complication in the form of perineal hematoma was resolved with conservative treatment and a case of urinary retention was resolved by placing a bladder catheter for the duration of one week. Three patients experienced perineal-scrotal dysesthesias that disappeared spontaneously in the first three months.

Conclusions: The described adjustable continence system has been found to be very effective in males with mild to moderate UI. In our experience, the ATOMS(®) implant offers excellent results over the middle term with a very low rate of complications that were easily resolved in all cases.

No MeSH data available.


Related in: MedlinePlus

The surgical technique. A. Components. B. Perineal incision. C. Bulbar Urethra Movilized. D. Tunneler application. E. ATOMS in place.
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Figure 0001: The surgical technique. A. Components. B. Perineal incision. C. Bulbar Urethra Movilized. D. Tunneler application. E. ATOMS in place.

Mentions: Our surgical technique is similar to that used by other groups, in all cases employing the suprapubic filling device instead of the recently marketed scrotal device [5–10]. Preoperative antibiotic prophylaxis is provided with a beta–lactam, following the recommendations of the current European guides [11]. With the patient in the lithotomy position, a longitudinal incision about 7–8 cm in length is made on the perineal midline, followed by dissection down to the bulbospongiosus muscle, which is preserved (Figure 1). Then, after identifying the ischiopubic rami, the left lateral mesh is inserted through the ipsilateral obturator orifice, emerging on the left lateral side of the bulbospongiosus muscle. The same procedure is carried out on the right side. Both bands are knotted, positioning the padding on the bulbospongiosus muscle at the urethral bulbar level, and anchored at four points by the lateral meshes. A transverse, left hypogastric incision about 2.5 cm in length is then made for housing the adjustable titanium port. The latter is fixed to the hypogastric subcutaneous tissue with Prolene 3/0 suture. Next, the subcutaneous tissue is dissected to form a superficial tunnel lateral to the spermatic cord (in the same way as for artificial sphincter preparation) extending to the implant site. A silicone connection is inserted through the tunnel joining the implant to the titanium port. Eight milliliters of saline solution is injected through the padding to achieve a degree of distension of the fixed implant, thereby applying slight compression upon the urethra. Layered closure of both incisions using loose Vicryl 3/0 stitches is then carried out. The bladder catheter is left in place for 24 hours and is removed before the patient is discharged. Oral antibiotic treatment is maintained up to 7 days after surgery. Subsequent follow–up comprises of a patient visit and micturition cystourethrography (MCU) four weeks after surgery to determine the objective and subjective implant results. Subsequent follow–ups depend on the primary pathology. An evolutive assessment is made of patient continence by administering as many fillings through the titanium port as needed to secure full urinary continence.


First experience with the ATOMS(®) implant, a new treatment option for male urinary incontinence.

González SP, Cansino JR, Portilla MA, Rodriguez SC, Hidalgo L, De la Peña J - Cent European J Urol (2014)

The surgical technique. A. Components. B. Perineal incision. C. Bulbar Urethra Movilized. D. Tunneler application. E. ATOMS in place.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310889&req=5

Figure 0001: The surgical technique. A. Components. B. Perineal incision. C. Bulbar Urethra Movilized. D. Tunneler application. E. ATOMS in place.
Mentions: Our surgical technique is similar to that used by other groups, in all cases employing the suprapubic filling device instead of the recently marketed scrotal device [5–10]. Preoperative antibiotic prophylaxis is provided with a beta–lactam, following the recommendations of the current European guides [11]. With the patient in the lithotomy position, a longitudinal incision about 7–8 cm in length is made on the perineal midline, followed by dissection down to the bulbospongiosus muscle, which is preserved (Figure 1). Then, after identifying the ischiopubic rami, the left lateral mesh is inserted through the ipsilateral obturator orifice, emerging on the left lateral side of the bulbospongiosus muscle. The same procedure is carried out on the right side. Both bands are knotted, positioning the padding on the bulbospongiosus muscle at the urethral bulbar level, and anchored at four points by the lateral meshes. A transverse, left hypogastric incision about 2.5 cm in length is then made for housing the adjustable titanium port. The latter is fixed to the hypogastric subcutaneous tissue with Prolene 3/0 suture. Next, the subcutaneous tissue is dissected to form a superficial tunnel lateral to the spermatic cord (in the same way as for artificial sphincter preparation) extending to the implant site. A silicone connection is inserted through the tunnel joining the implant to the titanium port. Eight milliliters of saline solution is injected through the padding to achieve a degree of distension of the fixed implant, thereby applying slight compression upon the urethra. Layered closure of both incisions using loose Vicryl 3/0 stitches is then carried out. The bladder catheter is left in place for 24 hours and is removed before the patient is discharged. Oral antibiotic treatment is maintained up to 7 days after surgery. Subsequent follow–up comprises of a patient visit and micturition cystourethrography (MCU) four weeks after surgery to determine the objective and subjective implant results. Subsequent follow–ups depend on the primary pathology. An evolutive assessment is made of patient continence by administering as many fillings through the titanium port as needed to secure full urinary continence.

Bottom Line: Three patients experienced perineal-scrotal dysesthesias that disappeared spontaneously in the first three months.The described adjustable continence system has been found to be very effective in males with mild to moderate UI.In our experience, the ATOMS(®) implant offers excellent results over the middle term with a very low rate of complications that were easily resolved in all cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hospital Universitario La Paz, Madrid, Spain.

ABSTRACT

Introduction: Urinary incontinence (UI) is defined as any complaint of involuntary urine leakage. A description is provided of our experience with the ATOMS(®) (Adjustable Transobturator Male System. Agency for Medical Innovations. A.M.I.) adjustable implant in patients with mild to moderate UI.

Material and methods: A retrospective study was made of the data referring to 13 patients treated with this adjustable system. Demographic and personal data were collected along with information on the etiology, severity, characteristics, duration of UI, complementary tests, surgery times, complications and results obtained.

Results: The full continence (no use of pad) recovery rate at the close of the study was 12/13 (92.3%). Three cases required a single filling during the mean 16 months of follow-up (range 4-32; median 14 months). A complication in the form of perineal hematoma was resolved with conservative treatment and a case of urinary retention was resolved by placing a bladder catheter for the duration of one week. Three patients experienced perineal-scrotal dysesthesias that disappeared spontaneously in the first three months.

Conclusions: The described adjustable continence system has been found to be very effective in males with mild to moderate UI. In our experience, the ATOMS(®) implant offers excellent results over the middle term with a very low rate of complications that were easily resolved in all cases.

No MeSH data available.


Related in: MedlinePlus