Stress urinary incontinence (SUI) following radical prostatectomy (RP) can impair quality of life (QoL). While surgical treatments have shown promising short-term results, data on long-term patient-reported outcomes remain limited.
To evaluate symptom burden, perceived improvement, and health-related quality of life (HRQoL) at extended follow-up after adjustable male obturator system (ATOMS) surgery.
Retrospective questionnaire-based observational study.
Men with post-RP SUI who underwent ATOMS implantation between 2012 and 2023 at a single tertiary centre were retrospectively identified (n = 111). Postoperative follow-up beyond the early postoperative period was conducted on an on-demand basis. Survivors (n = 99) were contacted and, following informed consent, completed the EPIC-26, RAND-12, and Patient Global Impression of Change questionnaires. Follow-up duration was defined as the time from ATOMS surgery to questionnaire completion.
Eighty-three patients participated (median age: 75 years; median follow-up: 87 months). At follow-up, 66% reported perceived improvement. Perceived improvement correlated with higher RAND-12 physical and mental scores. Pad use negatively correlated with both physical and mental HRQoL (r = -0.4, p < 0.001). Prior radiotherapy and higher BMI were associated with poorer EPIC-26 incontinence scores. RAND-12 scores were comparable to age-matched general population data. Device removal did not significantly impact HRQoL scores. At final follow-up, only 11% used were completely pad-free.
ATOMS surgery was associated with symptom improvement and favourable quality-of-life outcomes for most patients. In the context of an on-demand postoperative follow-up strategy without routine scheduled refilling, continence outcomes likely reflect the management model employed, and structured reassessment and refilling may therefore serve to optimise long-term results.
Quality of life after surgery for incontinence after radical prostatectomy This study assessed outcomes of 83 men with stress urinary incontinence (SUI) after radical prostatectomy who underwent ATOMS surgery between 2012 and 2023. 66% of patients reported perceived improvement. Improved urinary control was associated with better physical and mental quality of life, while higher BMI and prior radiotherapy predicted worse incontinence outcomes. Notably, overall health scores were comparable to the general population, and device removal did not significantly affect quality of life.
Therapeutic advances in urology. 2026 Apr 19*** epublish ***
Ingunn Roth, Karin Margrethe Hjelle, Christian Beisland, Christian Arvei Moen, Patrick Juliebø-Jones
Department of Urology, Haukeland University Hospital, Bergen, Norway., Department of Urology, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway.