ATOMS – Adjustable Transobturator Male System

ATOMS is made of biocompatible synthetic
material. The protective sleeve for the mesh
arms is made of LDPE and the Pull-in aid and
protective sleeve for the port is made of PTFE.
The permanent implant consists of monofi lament
(polypropylene) mesh arms with an integrated
HCR (high consistency rubber) silicone
cushion with fi xation sutures (polypropylene).
The cushion supports the bulbar urethra. The
pre-attached scrotal port (titanium and silicone)
provides an intra- or post-operative adjustment
by fi lling (or removing) volume of the cushion.
ATOMS is suitable for MRI examinations with
magnetic fi eld strengths up to 3 Tesla.

The suburethral sphincter cushion

The cushion applies compression to the m. bulbospongiosus and thereby to the urethra. This compression reduces involuntary loss of urine while still facilitating a physiological contraction to cause deliberate urination.

4-point fixation

The sling is a self-anchoring device and the symmetrical positioning of the cushion below the urethra is achieved by a 4-point fixation.
The integrated mesh arms are drawn back around the inferior pubic ramus to the middle of the implant to secure the system in place.

Scrotal Port

The attached port is positioned in the scrotum. Via the port, the fi lling volume of the cushion and thereby the compression to bulbospongiosus muscle is adjustable. Filling volume is adjusted using a non-coring port needle by the surgeon and depending on the patient´s anatomy and needs.


  • Self-anchoring implant – no need for additional fixation elements

  • Functional independency of patient’s mental and / or physical abilities (no manual activation/deactivation necessary)

Benefits [1] – [17]

  • Implant postoperatively adjustable for all degrees of incontinence in patients with an existing residual sphincter muscle function

  • Improved Quality of Life (QoL) in male patients with stress urinary incontinence (SUI)

  • Efficient improvement of incontinence in male patients with mild, moderate and severe stress-urinary incontinence (after radical prostatectomy/prostate surgery)

  • Postoperative adjustment of the implant by a minimal invasive treatment for multiple times to improve efficacy for each patient without increased risk of complications

  • Very low risk of intraoperative complications

A.M.I. Tunnellers

A.M.I. Tunnellers are multi-use devices, which are designed to meet the anatomic requirements for implant insertion. A slot at the tip enables the attachment of sling pull sutures, which are used to pull the implant in place.

ATOMS Tunneller and TOA Tunneller
The ATOMS and TOA Tunneller are intended to be used as an instrument to place the mesh arms around in inferior pubic ramus during ATOMS implantation to treat male stress urinary incontinence.


ATOMS animated video 

ATOMS live surgery video

[1] J. C. Angulo et al., “Patient satisfaction with adjustable transobturator male system in the Iberian multicenter
study,” World J. Urol., vol. 37, no. 10, pp. 2189–2197, Oct. 2019, doi: 10.1007/s00345-019-02639-4.

[2] J. C. Angulo, I. Arance, C. Esquinas, J. F. Dorado, J. P. Marcelino, and F. E. Martins, “Outcome Measures
of Adjustable Transobturator Male System with Pre-attached Scrotal Port for Male Stress Urinary
Incontinence After Radical Prostatectomy: A Prospective Study,” Adv. Ther., vol. 34, no. 5, pp. 1173–1183,
May 2017, doi: 10.1007/s12325-017-0528-5.

[3] J. C. Angulo et al., “Results of Adjustable Trans-Obturator Male System in Patients with Prostate
Cancer Treated with Prostatectomy and Radiotherapy: A Multicenter Study,” J. Clin. Med., vol. 12,
no. 14, p. 4721, Jul. 2023, doi: 10.3390/jcm12144721.

[4] W. Bauer and C. Brössner, “Adjustable transobturator male system – ATOMS – for the treatment of postprostatectomy
urinary incontinence : The surgical technique,” Pelviperineology, vol. 30, pp. 10–16, 2011,

[5] W. Bauer, M. Karik, and P. Schramek, “The self-anchoring transobturator male sling to treat stress
urinary incontinence in men: A new sling, a surgical approach and anatomical fi ndings in a cadaveric
study,” BJU Int., vol. 95, no. 9, pp. 1364–1366, 2005, doi: 10.1111/j.1464-410X.2005.05530.x.

[6] R. C. Doiron et al., “Canadian Experience with the Adjustable Transobturator Male System for Post-
Prostatectomy Incontinence: A Multicenter Study,” J. Urol., vol. 202, no. 5, pp. 1022–1028, Nov. 2019,
doi: 10.1097/JU.0000000000000420.

[7] J. F. Dorado and J. C. Angulo, “Refi ned Nomogram Incorporating Standing Cough Test Improves Prediction
of Adjustable Trans-Obturator Male System (ATOMS) Success to Treat Post-Prostatectomy Male Stress
Incontinence,” J. Pers. Med., vol. 12, no. 1, p. 94, Jan. 2022, doi: 10.3390/jpm12010094.

[8] C. Esquinas, I. Arance, J. Pamplona, A. Moraga, J. F. Dorado, and J. C. Angulo, “Tratamiento de la
incontinencia urinaria de esfuerzo tras prostatectomía con el sistema masculino transobturador ajustable
(ATOMS®) con puerto escrotal premontado,” Actas Urológicas Españolas, vol. 42, no. 7, pp. 473–482,
Sep. 2018, doi: 10.1016/j.acuro.2018.02.005.

[9] A. Friedl et al., “Long-term outcome of the adjustable transobturator male system (ATOMS): results of a
European multicentre study,” BJU Int., vol. 119, no. 5, pp. 785–792, May 2017, doi: 10.1111/bju.13684.

[10] A. Friedl, W. Bauer, M. Rom, D. Kivaranovic, W. Lüftenegger, and C. Brössner, “Sexuality and erectile
function after implantation of an Adjustable Transobturator Male System (ATOMS) for urinary stress
incontinence. A multi-institutional prospective study,” Arch. Ital. di Urol. e Androl., vol. 87, no. 4, p. 306,
Jan. 2016, doi: 10.4081/aiua.2015.4.306.

[11] P. Geretto et al., “Comparison Study between Artifi cial Urinary Sphincter and Adjustable Male Sling:
A Propensity-Score-Matched Analysis,” J. Clin. Med., vol. 12, no. 17, p. 5489, Aug. 2023, doi: 10.3390/

[12] A. Giammò and E. Ammirati, “Long-Term Survival Rate of ATOMS Implant for Male Stress Urinary
Incontinence and Management of Late Complications,” J. Clin. Med., vol. 12, no. 6, p. 2296, Mar. 2023,
doi: 10.3390/jcm12062296.

[13] S. Mühlstädt et al., “Five-year experience with the adjustable transobturator male system for the
treatment of male stress urinary incontinence: a single-center evaluation,” World J. Urol., vol. 35, no. 1,
pp. 145–151, Jan. 2017, doi: 10.1007/s00345-016-1839-x.

[14] S. Mühlstädt et al., “An overview of the ATOMS generations: port types, functionality and risk factors,”
World J. Urol., vol. 37, no. 8, pp. 1679–1686, Aug. 2019, doi: 10.1007/s00345-018-2548-4.

[15] F. Queissert et al., “ATOMS (Adjustable Transobturator Male System) Is an Effective and Safe Second-
Line Treatment Option for Recurrent Urinary Incontinence after Implantation of an AdVance/
AdVance XP Fixed Male Sling? A Multicenter Cohort Analysis,” J. Clin. Med., vol. 11, no. 1, p. 81, Dec. 2021,
doi: 10.3390/jcm11010081

[16] E. J. Redmond et al., “Multicentered Assessment of Clinical Outcomes and Factors Associated With
Failure of the Adjustable TransObturator Male System (ATOMS),” Urology, vol. 148, pp. 280–286, Feb. 2021,
doi: 10.1016/j.urology.2020.09.045.

[17] A. Ullate et al., “ATOMS (Adjustable Trans-Obturator Male System) in Patients with Post-Prostatectomy
Incontinence and Previously Treated Urethral Stricture or Bladder Neck Contracture,” J. Clin. Med.,
vol. 11, no. 16, p. 4882, Aug. 2022, doi: 10.3390/jcm11164882.

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