Intraoperative Urethral Pressure Measurements in Patients with Adjustable Transobturator Male System (Atoms) Can Help to Understand the Mode of Action of this Incontinence Device

Abstract

Male stress urinary incontinence (SUI) is a distressful complication of prostatic surgery either for prostate cancer or benign prostatic hyperplasia. Adjustable Transobturator male system (ATOMS) is increasingly used for the surgical treatment of male SUI. This system is based on ventral compression of the bulbar urethra by a filling a cushion. Compared to the artificial urinary sphincters the advantages of this system are its simplicity, the much lower risk of urethral atrophy or erosion, and the possibility of postoperative adjustment (1). However, its mode of action is not well understood. Our hypothesis is that the compression produced by the cushion filling produces a stretching effect on the bulbar urethra that increases urethral resistance and enhances the residual sphincteric activity, and also that different response to serial filling of the cushion intraoperatively after ATOMS placement could help to define the patients with best postoperative results.

We performed intraoperative measurement in a consecutive series of patients intervened with ATOMS to evaluate the relationship between cushion filling volume and intraurethral bulbar pressure at the place of ATOMS contact.