Use of the adjustable trans-obturator male sling system for the treatment of male incontinence. An initial experience

摘要

Objective To evaluate the safety and efficacy of the “Adjustable Trans-Obturator Male Sling System (ATOMS)” as a new surgical technique for the treatment of different types of male urinary incontinence. Subjects and methods Between March 2012 and December 2013, 9 patients with a mean age of 56 (range 15–74) years were operated for urinary incontinence using the ATOMS system. Incontinence had developed following bladder exstrophy repair in 2, after radical cystectomy with construction of an orthotopic neobladder in 3, after transvesical open prostatectomy in one and after radical prostatectomy in 3 patients. Preoperative evaluation included a detailed medical history, physical examination, 24-h pad tests, urodynamic assessment and sonography. Results The mean number of pads used preoperatively was 4.6 (range 3–6). The mean operative time was 45 (range 36–50) min. No intraoperative complications were encountered. The mean hospital stay was 3.8 (range 3–6) days. Transient perineal/scrotal pain was observed in 6 patients (66.7%) and controlled with non-opioid analgesics. There were no perineal infections; however, two port infections occurred (22.2%) and repositioning of the port was done in these cases. At a mean follow-up of 9 (range 6–12) months, the overall success rate was 100% with 77.8% of the patients being completely dry (0 pads per 24 h) and 22.2% using less than 2 pads per 24 h. Conclusions Our early experience demonstrated that the ATOMS system may be a safe and effective procedure for the treatment of male urinary incontinence. It has the advantage of being feasible any time after an operation when necessary. However, long-term follow-up on a large number of cases is required to ensure its long-term efficacy and safety.