ATOMS the urinary incontinence answer?

Luca Timossi1, Gian Maria Badano1, Corrado Pezzica1, Tomaso Montanaro1, Elvis Rikani1, Carlo Introini1
  • 1 Ospedale Evangelico Internazionale (Genova)

Objective

To Evaluate the medium and long term results after ATOMS implantation and the improvement in patients Quality of life.

Materials and Methods

We have analyzed the medium and long-term results of implant prosthetic sphincter ATOMS with a follow up of at least 6 months and a median follow-up of 12 months (6 to 36 months).
Patients treated 16 patients with ATOMS, all previously undergone open radical prostatectomy , 3 of these were underwent adjuvant RT after surgery who presents a mild-severe incontinence.
The average use of pad after prostatectomy, for at least 12 months after surgery, was 3 (range 2-6). In all ATOMS implantations we had no postoperative relevant sequelae, patients were discharged after 48 hours, in the first 6 cases, and 24 hours, in the following 10, after surgery.

Results

Upon removal of the bladder catheter 75% of patients (12) had already an improvement in urinary continence pad daily with a decrease of about 20% .
The first injection in the prosthesis was performed in all patients with 10cc of saline 20 days after surgery. Following this the 43,75% of the patients (7 patients) were continents. At the second control after surgery at day 40 9 patients that still have urinary incontinence have been injected yet a further 5 cc of normal saline with improvement of continence in all patients. 6 patients were completely continent at this point still using the remaining 3 1 2 die pad while the other two first die pad. At 60 days of surgery were injected to the 3 patients in which still remained urinary incontinence have increased the cuff inflation further 5 cc reaching continence in all treated cases.
After about 6 months after surgery all patients were to be treated by us continents only 2 patients still using one die pad as security.In 3 cases the first injection results impossible because the port was dislocated and we need to perform a small incision over the scar with a local anesthesia to replace the port in the correct position.
All patients had a significantly improved Qol.

Discussions

Atoms implantation results easy to perform and requires a short learning curve with low risks for the patients.The possibility to adjust the urethral compression during the time allow the urologist, and also the patience to improve urinary incontinence on demand even after several months with a safety procedure perform in office without the need for surgical intervention as is instead necessary with other implant.
The results of our study show that the urinary continence has been reached in all patients treated by this implant and the medium and long term results encouraging us to continue the use of this disposable.

Conclusion

Prostate cancer is the sixth most common cancer worldwide and will include about 30% of all malignancies in men.Whit the increase of the diagnosis is correlated an icreas of surgical treatment and their related sequelae.
Urinary incontinence is still today one of the late sequelae after radical prostatectomy that most affect the quality of life of the patient. In our experience this device results easy to implant and safety for the patient.
We believe that ATOMS rappresent the most suitable solution in the treatment of severe and moderate incontinence. The possibility of adjusting the compression exerted urethral allows to achieve excellent late results than with other principals could not be obtained.

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