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#327

Adjustable TransObturator Male Sling (ATOMS®) for male neurogenic stress urinary incontinence: report on initial experience. Castaño-Botero J1, Chinkovsky-Rios A1, Torres-Jauregui P2 1. Department of Urology. Universidad/clínica CES, Medellín, Col., 2. Department of urogynecology and pelvic floor. Universidad Pontificia Bolivariana, Medellín, Col. KEYWORDS: Male, Stress Urinary Incontinence, Spinal Cord Injury In this original retrospective case series study, we asses Adjustable Transobturator Male Sling ATOMS® (Agency for Medical Innovations GmbH, Feldkirch, Austria) in male patients with stress urinary incontinence (SUI) related to neurogenic lower urinary tract dysfunction (NLUTD). This population pose a complex scenario in which urinary incontinence can be related to intrinsic sphincteric deficiency (ISD) as in sacral spinal cord injury (SCI), peripheric pelvic nerve trauma, congenital malformations (myelomeningocele, epispadias/exstrophy complex) and acquired progressive neuropathies affecting peripheral pelvic nerves, or may correspond also to mixed urinary incontinence if the patient courses with concomitant neurogenic detrusor overactivity (NDO). Vast experience exists in the management of male SUI secondary to prostatic surgery. Diverse techniques have been evaluated with good efficacy and low adverse events, nevertheless for neurogenic male SUI evidence is scarce. Artificial urinary sphincter (AUS) has been evaluated in this context and represents the majority of trials when compared to another devices as male alloplastic slings, implantable adjustable devices (ProACT/ACT®) and peri urethral bulking agents (1). Therefore, current guidelines recommend the insertion of AUS in male patients with neurogenic SUI, considering it an option with acceptable continence long-term outcomes but recognizing the elevated failure and re-operation rates and non-mechanical complications which are higher than in non-NLUTD patients. A considerable proportion of patients with neurogenic SUI need intermittent catheterization (IC) which is considered an independent risk factor for urethral erosion in presence of AUS regardless its bulbar or periprostatic/cervical positioning. Besides, patients with NLUTD may exhibit troubles with activation pump which would do them unsuitable for this kind of device. The ATOMS is a ventral bulbar urethral compression device which easily allows for in-office adjustments by means of injections of fluid trough a scrotal port. Consists of a central silicone cushion attached by mesh arms to ischiopubic rami bilaterally. ATOMS® was created in 2008 and modified lastly in 2014 to include the pre-attached silicone-covered scrotal port. Recently Angulo and Esquinas published a meta-analysis about effectiveness and safety of the ATOMS® in the treatment of male SUI after prostate surgery (2). Treatment with ATOMS® resulted in a mean 67% (95% CI 0.61-0.72) dryness rate and 90% (95% CI 0.86-0.94) improvement. With a mean follow up of 20.9 months the proportion of patients with device explanted was 5.75% and complication rate was 16% (95% CI 0.12-0.21). Most published series lack of urethral erosion since bulbo-spongiosus muscle is not incised, neither a circumferential force is applied to the urethra. We aim to asses ATOMS® as a probably safer anti-incontinence device, given its bulbar localization and its potential fewer risk of urethral erosion and the possibility to adjust the bulbar compression in an outpatient basis. It could be a good alternative to the AUS in male neurogenic SUI. There is no evidence in the current literature concerning the use of ATOMS® in male patients with neurogenic SUI. Series do not include NLUTD population and data about its efficacy and safety is inexistent. To our knowledge this is the first report about the use of ATOMS® in neurogenic SUI. Herein we retrospectively evaluate our initial experience in 5 patients with neurogenic SUI in whom ATOMS® was implanted. Read the full abstract text here: https://www.ics.org/2020/abstract/327