Unraveling the Knot: The Impact of Distal vs. Proximal Implantation Technique on Adjustable Transobturator Male Sling (ATOMS) Outcomes for the Treatment of Stress Urinary Incontinence.

OBJECTIVES

To evaluate and compare the feasibility, safety, and efficacy of the classic and a novel, proximal implantation technique of the Adjustable Transobturator Male System (ATOMS) in patients with severe Post-Prostatectomy-Incontinence.

PATIENTS AND

METHODS

This retrospective cohort comprised 131 male patients who received ATOMS implants for severe PPI between November 2018 and May 2024. The classic, distal technique was applied up to July 2021, after which the proximal technique was exclusively adopted. Baseline data, intraoperative details, and postoperative results were documented. Follow-up was obtained cross-sectionally in November 2024, covering continence outcomes and patient satisfaction using validated questionnaires.

RESULTS

Baseline characteristics were comparable between groups. The proximal technique required greater initial cushion-filling volume but fewer postoperative adjustments. Early continence outcomes were similar, with both groups achieving a median of 1.0 pad/day and a full continence rate of 54.0%. At follow-up, the proximal cohort demonstrated superior functional results, including higher complete continence rates (64.6% vs. 38.1%) and greater patient satisfaction. Patients in the proximal group reported lower ICIQ-SF scores and a higher likelihood of recommending the procedure. Postoperative urgency was less frequent. Although residual urine occurred more often with proximal implantation, rates of urinary retention, surgical complications, and explantation did not differ.

CONCLUSION

The proximal technique offers good long-term continence outcomes, higher patient satisfaction, and fewer urgency symptoms while maintaining a comparable complication profile. Short- and long-term results seem superior to the classic method, though interpretation of long-term data is limited by unequal follow-up durations. Overall, our findings support the proximal approach as the preferred method for ATOMS implantation.