Adjustable TransObturator Male System (ATOMS) After Desobstructive Surgery for Benign Prostatic Hyperplasia – Does the Type of Desobstructive Surgery Make a Difference?

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.