ATOMS – Adjustable Transobturator Male System
Hydraulic system substitutes urinary sphincter function in incontinent males
- Long-term, adjustable implant
- Hydraulic system with no mechanical parts
- Anatomical 4-point fixation
ATOMS is suitable for all degrees of urinary incontinence, and can also be used after radiotherapy.
The suburethral substitute sphincter cushion
4-point fixation
The flexibility
Functional independency of patient’s mental and/or physical abilities (no manual activation/deactivation necessary):
Hydraulic System
ATOMS is made up entirely of components that function hydraulically. Patients are therefore spared the difficulties caused by defects which may occur in mechanical components months or years after the implantation.
Increase in volume
Individual, long-term adjustment of pressure on urethra
Features of ATOMS
Why a mesh that loops around the inferior pubic ramus?
Firmer hold and infection prophylaxis.
The ingenious, patented idea of looping the mesh around the bone as a holding structure is worth mentioning. The integrated mesh will be placed around the inferior pubic ramus, which leads to several advantages: The macroporous mesh integrates well into the tissue. The engraftment leads to an extra firm hold, which is relevant for optimal surgical results. In addition to the firm hold, the macroporous mesh also offers the advantage of reduced foreign body reactions. Tissue ingrowth and revascularization of the surrounding tissue reduce the risk of an infection spreading in the pelvis operatively or post-operatively.
Why a large cushion?
Atrophy reduction and erosion prophylaxis.
The effect of the implant is simple: The urologist determines the fill volume of the cushion. A compression of the bulbospongiosus muscle, indirectly of the urethra, increases the urethral resistance. The contraction of the bladder will make a physiological urination possible, but an involuntary loss of urine is reduced or ideally avoided. The size of the cushion determines the pressure on the bulbospongiosus muscle, and the smaller the cushion, the more punctate the pressure is. The soft compression of the large ATOMS cushion allows a low pressure, and a low tissue pressure leads to low atrophy. Limited tissue atrophy means lower risk of erosion. A very limited number of urethral erosions is known to A.M.I. after 15 years of experience with ATOMS, and those few cases were usually associated with a difficult patient situation (e.g. following previous cuff erosion of an artificial urinary sphincter).1
Why does the catheter attach lateral and exit dorsal?
Compliant with the anatomy.
The catheter outgoing, laterally on top of the cushion, displays straight in the direction of the scrotum. It proceeds without kinks and it touches no other parts of the implant. It proceeds the shortest way on the left side of the scrotum. If necessary, the implant can be adjusted post-operatively by means of a simple percutaneous puncture of the port – even years after the implantation.
Parts of ATOMS
- Suburethral substitute sphincter cushion
- Catheter
- Scrotal Port
- Mesh arms for fixation
- Fixation sutures
- Tunneller
Placement of ATOMS
The distal, suburethral placement of the implant underneath the bulbospongiosus muscle allows for use of ATOMS even after radiotherapy. The symmetrical positioning below the urethra is achieved by a 4-point fixation. The small, pre-attached scrotal port is palpated with ease by the urologist. Filling the implant with saline solution or emptying it is performed with a simple percutaneous needle puncture.
1 Esquinas, C., & Angulo, J. C. (2019). Effectiveness of Adjustable Transobturator Male System (ATOMS) to Treat Male Stress Incontinence: A Systematic Review and Meta-Analysis. Advances in Therapy, 36(2), 426–441. https://doi.org/10.1007/s12325-018-0852-4