OBJECTIVE:To assess the surgical safety, efficacy and quality of life in patients suffering from stress urinary incontinence after desobstructive surgery for benign prostatic enlargement, we analyzed data from patients treated with the Adjustable Transobturator Male System (ATOMS) at our tertiary referral center. METHODS:We retrospectively analyzed 27 patients with stress urinary incontinence (SUI) after desobstructive surgery (transurethral resection of the prostate (TUR-P): n = 17; Holmium laser enucleation of the prostate (HoLEP): n = 10) who underwent ATOMS implantation at our high-volume incontinence-surgery center between 2018 and 2024. Patients with prior prostatectomy or cancer-related surgery were excluded. Pre- and postoperative continence parameters, complications, and patient-reported outcomes were assessed using questionnaires, 24-h pad tests, and standardized instruments. The median follow-up was 32 months. RESULTS:Baseline demographics were comparable across groups. HoLEP patients had a significantly higher resected tissue weight (95.0 g vs. 26.0 g, p = 0.008) and required greater cushion volume (8.0 ml vs. 7.0 ml, p = 0.035). Complete continence rates were 64.7% (TUR-P) and 80.0% (HoLEP, p = 0.401). Postoperative pad test results (12.0 ml vs. 11.0 ml), complication rates, and satisfaction levels showed no significant differences. Explantation occurred in ~10% of patients, with high patient-reported satisfaction and willingness to recommend the implant across both groups. CONCLUSION:ATOMS implantation is a feasible, safe, and effective treatment for SUI following both TUR-P and HoLEP. Importantly, neither the type of prior surgery nor the volume of resected prostate tissue negatively impacted outcomes. These findings support the broader application of ATOMS in patients with post-BPE SUI, including those with large prostate volumes.

AIMS:To evaluate the impact of radical prostatectomy (RP) modality on functional outcomes, safety, and patient satisfaction following Adjustable Transobturator Male System (ATOMS) implantation. Incontinence after prostate treatment (IPT) is a challenging complication of RP. While ATOMS is an established option for IPT, the influence of RP approach-open RP (ORP) versus robot-assisted RP (RARP)-on outcomes has not been investigated. METHODS:We retrospectively analyzed 131 men undergoing ATOMS implantation for severe IPT after RP (11/2018-05/2024). Patients with prior incontinence surgery, non-RP-related IPT, or urgency/mixed incontinence were excluded. Propensity score matching (1:1; caliper 0.2) for age, interval from RP to ATOMS, locally advanced disease, and prior pelvic radiotherapy yielded 106 matched patients. Primary endpoints were complete continence (0 pads/day), daily pad usage, 24-h pad test, satisfaction, and device explantation. Secondary endpoints included perioperative parameters and complications. RESULTS:RARP patients achieved higher immediate complete continence rates (60.8% vs. 39.2%, p = 0.032), lower daily pad usage (1.0 vs. 2.0 pads, p = 0.048), and fewer explantations (3.8% vs. 15.0%, p = 0.046) than ORP patients. Perioperative parameters and complication rates did not differ. Long-term functional outcomes, satisfaction (84% vs. 76%), and recommendation rates (92% vs. 84.6%) were comparable. CONCLUSIONS:This first comparative analysis of ATOMS outcomes by RP modality found RARP to be associated with superior early continence and lower explantation rates, potentially reflecting improved periurethral preservation. However, long-term efficacy, safety, and satisfaction were equivalent, supporting ATOMS as an effective treatment regardless of RP approach.

Objectives To evaluate and compare the feasibility, safety, and efficacy of the classic and a novel, proximal implantation technique of the Adjustable Transobturator Male System (ATOMS) in patients with severe Post-Prostatectomy-Incontinence.Patients and Methods This retrospective cohort comprised 131 male patients who received ATOMS implants for severe PPI between November 2018 and May 2024. The classic, distal technique was applied up to July 2021, after which the proximal technique was exclusively adopted. Baseline data, intraoperative details, and postoperative results were documented. Follow-up was obtained cross-sectionally in November 2024, covering continence outcomes and patient satisfaction using validated questionnaires.Results Baseline characteristics were comparable between groups. The proximal technique required greater initial cushion-filling volume but fewer postoperative adjustments. Early continence outcomes were similar, with both groups achieving a median of 1.0 pad/day and a full continence rate of 54.0%. At follow-up, the proximal cohort demonstrated superior functional results, including higher complete continence rates (64.6% vs. 38.1%) and greater patient satisfaction. Patients in the proximal group reported lower ICIQ-SF scores and a higher likelihood of recommending the procedure. Postoperative urgency was less frequent. Although residual urine occurred more often with proximal implantation, rates of urinary retention, surgical complications, and explantation did not differ.Conclusion The proximal technique offers good long-term continence outcomes, higher patient satisfaction, and fewer urgency symptoms while maintaining a comparable complication profile. Short- and long-term results seem superior to the classic method, though interpretation of long-term data is limited by unequal follow-up durations. Overall, our findings support the proximal approach as the preferred method for ATOMS implantation.

INTRODUCTION:Post-prostatectomy stress urinary incontinence (SUI) significantly impairs patients' quality of life. While the artificial urinary sphincter (AUS) is considered the gold standard for managing severe SUI, a subset of patients is not suitable for this intervention. This study aimed to evaluate the clinical outcomes of patients who received an adjustable transobturator male system (ATOMS) as an alternative to AUS for the treatment of SUI. METHODS:In this single-center retrospective study, we included 25 patients who received ATOMS implantation for post-prostatectomy SUI, despite being technically eligible for AUS based on incontinence severity and pelvic floor status. Primary outcomes included pad usage, continence rates, complications, and patient-reported satisfaction. A cross-sectional follow-up was conducted in using standardized questionnaires. RESULTS:Median age was 74.0 years; 60% of patients had undergone pelvic radiotherapy. Preoperative median pad usage was 6.0/day, reduced to 3.0/day postoperatively. Social continence (≤1 pad/day) was achieved in 16%, and ≥50% reduction in pad usage in 76% of patients. Complications were mostly minor. Cross-sectional follow-up data were available for 60% of patients at a median of 42 months. Patient satisfaction was high (73.3%), and 80% would recommend the procedure. According to the PGI score, 73.3% reported "very much" or "much improved" outcomes. CONCLUSION:ATOMS represents a feasible and safe treatment alternative for patients with severe SUI who are unable or unwilling to undergo AUS implantation. Despite suboptimal continence outcomes compared to AUS, high satisfaction and acceptable complication rates support its use in appropriately selected patients.

Background and objective:Stress urinary incontinence (SUI) remains a debilitating complication after treatment for prostate cancer or benign prostatic obstruction. While artificial urinary sphincter (AUS) implantation is the gold standard, sling procedures are widely adopted for selected patients. We aimed to analyze long-term trends, perioperative outcomes, and explantation patterns of AUS and sling procedures for male SUI in Germany. Methods:We performed a population-based study using the German Nationwide Inpatient Sample (GRAND) from 2005 to 2023. Men undergoing AUS or sling implantation were identified through procedure codes. Primary outcomes were in-hospital morbidity, mortality, and length of stay (LOS). Multivariable regression models were adjusted for age, comorbidities, prior radiotherapy, and year of surgery. Reasons for explantation and reimplantation were also assessed. Key findings and limitations:A total of 24 234 men underwent SUI surgery (AUS: 63%, nonadjustable sling: 32%, and adjustable sling: 4.7%). Median age was 72 yr. AUS implantation remained most frequent, although it declined slightly in recent years. Use of nonadjustable sling peaked in 2012 but decreased thereafter, whereas use of adjustable sling procedures increased steadily. Procedure volumes markedly decreased during COVID-19. Perioperative mortality was <0.1% across groups. Nonadjustable slings were associated with a higher risk of acute urinary retention (odds ratio [OR]: 1.1, p = 0.020) but with a lower risk of wound infection (OR: 0.5, p < 0.001) than AUS. No statistically significant differences were observed between adjustable slings and AUS in terms of perioperative morbidity. LOS was longer in AUS (median 6 d) than in slings (median 5 d; p < 0.001). Two-cuff AUS were associated with longer LOS than single-cuff devices. Explantations occurred most often due to infection or mechanical failure for AUS, and for different reasons for slings. Limitations include reliance on administrative coding without functional or long-term patient-reported outcomes. Conclusions and clinical implications:Male SUI surgery is safe, with AUS remaining the most frequent procedure in Germany. Adjustable slings represent an expanding option for selected patients.

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.

Background and objective: Urology is characterized by continuous innovation. The inception of robot-assisted radical prostatectomy (RP) marked a pivotal technological advance and further advances in digital treatment options for stress urinary incontinence (SUI) are emerging. Our aim was to assess patient willingness to receive an electronic artificial urinary sphincter (eAUS) implant and identify associated concerns. Methods: Patients who received a first AUS implant (AMS800 system) for post-RP SUI from March 2013 to December 2023 were included. An anonymous survey was used to collect data on demographics, current AUS satisfaction, daily technology use, interest in an eAUS, and concerns about potential eAUS technical malfunctions. Data were analyzed using SPSS, with significance set at p < 0.05. Key findings and limitations: Out of 345 patients, 208 (60.2%) completed the questionnaire. The majority were aged 71-80 yr (51.7%) and had a university education (37.7%). Satisfaction with their AUS was high: 79.8% of the respondents were satisfied, 88.9% were satisfied with its handling, and 89.4% would choose an AUS implant again. Notably, 60.4% showed interest in an eAUS, with younger respondents and those who use technology on a daily basis expressing greater interest. Preferred control methods included remote-based (78.4%) and smartphone-based (60.0%) options. Concerns about system malfunction (66.4%), connection loss (65.9%), and battery issues (60.0%) were prevalent. Conclusions and clinical implications: There was significant patient interest in an eAUS in our survey, especially among younger individuals and those who use technology daily. Despite high satisfaction with current AUS devices, addressing potential technical malfunctions and patient concerns is crucial for broader acceptance of an eAUS. Patient concerns about technological malfunctions seem to outweigh worries about medical issues. Patient summary: Urology is becoming more advanced with technologies like robotic surgery and electronic artificial urinary sphincters (eAUS). According to our survey, most patients are happy with their current sphincters and are open to eAUS, especially younger patients who are familiar with technology. However, patients are concerned about system malfunctions and connection loss. More research is needed to address technical issues and patient concerns. (c) 2025 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

Background: Stress urinary incontinence in men is predominantly iatrogenic after radical prostatectomy or transurethral interventions. Current studies show that there is a deficit in the availability of surgical therapy not only in Germany. The aim of this study is to investigate in more detail the structural health care situation of surgical treatment of male stress incontinence in Germany. Materials and methods: The evaluation of the surgical therapy of male stress incontinence in Germany is based on the OPS (Operationen- und Prozedurenschl & uuml;ssel-German procedural classification) codes from hospital quality reports from 2011-2019. Results: From 2012-2019, the number of male incontinence surgeries declined from 2191 to 1445. The number of departments performing incontinence surgeries decreased from 275 to 244. In the multivariate analysis, a high number (>= 50) of radical prostatectomies/year (RPE/year) is an independent predictor of a high-volume centre (>= 10 procedures/year; odds ratio [OR] 6.4 [2.3-17.6]; p < 0.001). The most significant decrease was in sling surgery (from 1091 to 410; p < 0.001). Here, the number of cases decreased especially in departments that implanted a high number of slings (>= 10 slings/year; -69%; -62.4 +/- 15.5 surgeries/year; p = 0.007). In addition, the number of departments implanting slings decreased over the investigated time period (from 34 to 10; p < 0.001). This particularly affected departments that also had a low number of RPE/year (from 9 to 0; -100%). Conclusion: The situation of surgical treatment of male stress urinary incontinence in Germany shows a clear decline in sling implantation, especially in small departments. On the one hand, this reflects the increasingly differentiated indications for sling implantation. On the other hand, it raises the suspicion that a gap in care has developed, as the decline was not compensated for by other surgical therapies.

Die Belastungsharninkontinenz ist zumeist iatrogen bedingt. Die radikale Prostatektomie ist hierfür die häufigste Ursache. Der Pathomechanismus ist wahrscheinlich multifaktoriell. Die differenzierte präoperative Diagnostik vor einer operativen Therapie erscheint Erfolg entscheidend für gute postoperative Ergebnisse. Es kommen verschiedene operative Systeme zum Einsatz. Der künstliche Schließmuskel gilt weiterhin als Referenzverfahren mit hoher Erfolgsrate auch bei komplexen Patienten und ausgeprägter Harninkontinenz. Allerdings bestehen auch relevante Komplikations- sowie Revisionsraten. Moderne Alternativen sind die verschiedenen Schlingensysteme. Die adjustierbaren Schlingensysteme bestehen aus einem Kissen, welches im Bereich der bulbären Harnröhre platziert wird und zu einer dauerhaften Erhöhung des urethralen Widerstands führt, welcher nachadjustiert werden kann. Die Systeme können auch bei beispielsweise vorbestrahlten Patienten eingesetzt werden. Die AdVance XP™-Schlinge (Boston Scientific, Marlborough, MA, USA) ist eine fixierte Schlinge, welche eine Korrektur des Absinkens der hinteren Harnröhre nach radikaler Prostatektomie vornimmt und so zu einer Verlängerung der funktionellen Verschlussstrecke führt. Gute Ergebnisse auch im Langzeitverlauf sind nur bei selektionierten Patienten möglich.

Die Belastungsinkontinenz des Mannes ist überwiegend iatrogen bedingt. Aktuelle Studien zeigen nicht nur in Deutschland ein Versorgungsdefizit in der operativen Therapie. Ziel ist es, die strukturelle Versorgung der operativen Therapie der männlichen Belastungsinkontinenz in Deutschland detaillierter zu untersuchen. Die Auswertung der strukturellen Versorgung durch Belastungsinkontinenzoperationen des Mannes in Deutschland erfolgt anhand von OPS-Codes der Qualitätsberichte der Krankenhäuser von 2011 bis 2019. Von 2012 bis 2019 zeigt sich ein Rückgang der Inkontinenzoperationen beim Mann von 2191 auf 1445. Die Zahl der Kliniken, die Inkontinenzoperationen durchführen, fiel von 275 auf 244. In der multivariaten Analyse ist eine hohe Zahl (n ≥ 50) an radikalen Prostatektomien/Jahr (RPE/Jahr) ein unabhängiger Prädiktor für eine High-volume-Klinik (≥ 10 Eingriffe/Jahr: Odds Ratio [OR] 6,4 [2,3–17,6]; p < 0,001). Ein deutlicher Rückgang ist bei Schlingenoperationen (von n = 1091 auf 410; p < 0,001) zu verzeichnen. Hier sank besonders die Fallzahl in Kliniken, die eine hohe Zahl an Schlingen implantierten (≥ 10 Schlingen/Jahr; −69

Aim This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091) was published in December 2021. This guideline combines and summarizes earlier guidelines such as "Female stress urinary incontinence," "Female urge incontinence" and "Use of Ultrasonography in Urogynecological Diagnostics" for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft fur Gynakologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft fur Urogynakologie und plastische Beckenbodenrekonstruktion e. V., AGUB). Methods This S2k- guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline "Urinary Incontinence in Adults" published by the European Association of Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated. Recommendations The short version of this guideline consists of recommendations and statements on the surgical treatment of female patients with stress urinary incontinence and urge incontinence. Specific solutions for the diagnostic workup and treatment of uncomplicated and complicated urinary incontinence are discussed. The diagnostics and surgical treatment of iatrogenic urogenital fistula are presented.

Aim This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091) was published in December 2021. This guideline combines and summarizes earlier guidelines such as "Female stress urinary incontinence," "Female urge incontinence" and "Use of Ultrasonography in Urogynecological Diagnostics" for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft fur Gynakologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft fur Urogynakologie und plastische Beckenbodenrekonstruktion e. V., AGUB). Methods This S2k-guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline "Urinary Incontinence in Adults" published by the European Association of Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated. Recommendations The short version of this guideline consists of recommendations and statements on the epidemiology, etiology, classification, symptoms, diagnostics, and treatment of female patients with urinary incontinence. Specific solutions for the diagnostic workup and appropriate conservative and medical therapies for uncomplicated and complication urinary incontinence are discussed.

Background: Circular urethral compression with an artificial sphincter allows control of voiding, even in patients with severe stress urinary incontinence, but it heightens the risk of urethral atrophy and erosion. This study of one of the largest populations of patients treated with radiotherapy investigates the additive effect of the post-radiogenic stricture of the membranous urethra/bladder neck on AMS 800 artificial urinary sphincter outcomes. Methods: In a retrospective multicenter cohort study, we analyzed patients fitted with an AMS 800, comparing those who had received radiotherapy with patients presenting a devastated bladder outlet (stricture of the membranous urethra/bladder neck). We determined the correlation between these groups of patients using both univariate and stepwise adjusted multivariate regression. The revision-free interval was estimated by a Kaplan–Meier plot and compared by applying the log-rank test. A p value below 0.05 was considered statistically significant. Results: Of the 123 irradiated patients we identified, 62 (50.4%) had undergone at least one prior desobstruction for bladder-neck/urethra stenosis. After a mean follow-up of 21 months, the latter tended to achieve social continence less frequently (25.7% vs. 35%; p = 0.08). Revision was required significantly more often for this group (43.1% vs. 26.3%; p = 0.05) due to urethral erosion in 18 of 25 cases. A stenosis recurred in five cases; desobstruction was performed in two cases, leading to erosion in both. Multivariate analysis revealed a significantly higher risk of revision when recurrent stenosis necessitated at least two prior desobstructions (HR 2.8; p = 0.003). Conclusions: A devastated bladder outlet is associated with a lower proportion of men with social continence and a significantly higher need for revision compared with irradiated patients without a history of urethral stenosis. Alternative surgical procedures should be discussed beforehand, especially in cases of recurrent urethral stenosis.