Open vs. Robotic Radical Prostatectomy: Impact on Adjustable Transobturator Male Sling (ATOMS) Outcomes for the Treatment of Stress Urinary Incontinence.

AIMS: To evaluate the impact of radical prostatectomy (RP) modality on functional outcomes, safety, and patient satisfaction following Adjustable Transobturator Male System (ATOMS) implantation. Incontinence after prostate treatment (IPT) is a challenging complication of RP. While ATOMS is an established option for IPT, the influence of RP approach-open RP (ORP) versus robot-assisted RP (RARP)-on outcomes has not been investigated.

METHODS

We retrospectively analyzed 131 men undergoing ATOMS implantation for severe IPT after RP (11/2018-05/2024). Patients with prior incontinence surgery, non-RP-related IPT, or urgency/mixed incontinence were excluded. Propensity score matching (1:1; caliper 0.2) for age, interval from RP to ATOMS, locally advanced disease, and prior pelvic radiotherapy yielded 106 matched patients. Primary endpoints were complete continence (0 pads/day), daily pad usage, 24-h pad test, satisfaction, and device explantation. Secondary endpoints included perioperative parameters and complications.

RESULTS

RARP patients achieved higher immediate complete continence rates (60.8% vs. 39.2%, p = 0.032), lower daily pad usage (1.0 vs. 2.0 pads, p = 0.048), and fewer explantations (3.8% vs. 15.0%, p = 0.046) than ORP patients. Perioperative parameters and complication rates did not differ. Long-term functional outcomes, satisfaction (84% vs. 76%), and recommendation rates (92% vs. 84.6%) were comparable.

CONCLUSIONS

This first comparative analysis of ATOMS outcomes by RP modality found RARP to be associated with superior early continence and lower explantation rates, potentially reflecting improved periurethral preservation. However, long-term efficacy, safety, and satisfaction were equivalent, supporting ATOMS as an effective treatment regardless of RP approach.