ObjectivesTo assess outcomes of continence and complications after implantation of Adjustable TransObturator Male System (ATOMS) for the treatment of male stress urinary incontinence (SUI). Materials and MethodsData of 80 patients receiving an ATOMS implatation between 2010 and 2021 at a tertiary academic referral centre were retrospectively analyzed. Primary endpoints were outcomes of continence and complications. Implant survival rate was estimated by the Kaplan-Meier method, risk factors for explantation were analyzed by univariable Cox regression. ResultsDuring a median follow-up of three yrs. the number of pads decreased significantly from four to two pads per day (p<0.001). After five yrs., 17 patients experienced an explantation, eight of them during the first year following ATOMS implantation, resulting in one- and five-year-implant-survival rates of 0.89 (95%CI:0.80-0.95) and 0.71 (95%CI:0.56-0.81), respectively. During the total observation time, ATOMS was explanted in 22 (27.5%) patients (Kaplan-Meier estimate for explantation: 0.35 [95%CI:0.09-0.64]) after a median time of 2.3 (0.1, 10.2) yrs. The risk for explantation was higher in patients after previous incontinence surgery (HR=3.4, 95%CI:1.4-8.2, p=0.007), ISUP (International Society of Urological Pathology) > 4 (Gleason score >8) in surgery specimens (HR=4.4, 95%CI:1.03-27.1 compared to ISUP 1, p=0.046), and a preoperative daily pad weight >250g (HR=3.1, 95%CI:1.18-8.17, p=0.022). ConclusionATOMS lead to a significant reduction of pad usage. During the intermediate-term follow-up approximately every 3rd patient experienced device explantation. In particular, patients with recurrent SUI and patients with severe SUI have to be warned about a relevant risk of explantation.
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