Adjustable TransObturator Male System (ATOMS) After Radiotherapy: Is Timing Everything? A Single-Center Experience.

Abstract

Introduction: Incontinence after prostate treatment (IPT) following radical prostatectomy and/or radiotherapy for prostate cancer significantly impacts quality of life. While the Adjustable Transobturator Male System (ATOMS) is a promising surgical option for IPT, data on outcomes in patients undergoing ATOMS implantation with prior radiotherapy are limited. This study evaluates the influence of prior radiotherapy-and its timing-on outcomes following ATOMS implantation.

Materials and methods: This retrospective single-center study included 131 men treated with ATOMS for IPT between November 2018 and May 2024. Patients were stratified by history of having received radiotherapy and also by timing of radiotherapy ( ≤ 24 vs. > 24 months) before ATOMS implantation. Pre-, peri-, and postoperative variables were recorded. Cross-sectional follow-up was conducted in November 2024 using clinical questionnaires, 24-h-pad-tests, and validated instruments (PGI, ICIQ-UI). Statistical analysis included t-tests, Mann-Whitney U tests, Chi-square tests, Kaplan-Meier curves, and Cox regression.

Results: Forty seven patients (35.9%) received radiotherapy before ATOMS implantation. These patients had higher tumor stages and Gleason scores. Postoperatively, radiated patients demonstrated lower complete continence rates (21% vs. 51%, p = 0.020) and higher median pad use (2.5 vs. 1, p < 0.01). Furthermore, they experienced higher rates of acute urinary retention (8.5% vs. 0%, p = 0.029) and explantation (21% vs. 6%, p = 0.018). No significant differences in satisfaction, long-term continence, or outcomes were found based on the timing of radiotherapy.

Conclusion: ATOMS is an adequate treatment for IPT regardless of radiotherapy history or timing before its implantation. Although significant differences in immediate continence rates were observed (21% vs. 51%), long-term continence rates were comparable. Therefore, ATOMS seems to be a viable option in this patient population.