1. ATOMS DEVICE FOR MALE URINARY INCONTINENCE: A READJUSTABLE AND REPRODUCIBLE SYSTEM DR.EMILIO GUTIERREZ MINGUEZ Department of Urology HOSPITAL UNIVERSITARIO DE BURGOS

2. ETIOLOGY OF INCONTINENCE NEUROGENIC BLADDER. NEUROGENIC BLADDER. EVOLUTIONARY PROSTATICS. EVOLUTIONARY PROSTATICS. RADICAL PROSTATECTOMY. RADICAL PROSTATECTOMY. TURP / ADENOMECTOMY PROSTATE. TURP / ADENOMECTOMY PROSTATE. RADIOTHERAPY. RADIOTHERAPY.

3. FRECUENCY THE MOST COMMON CAUSE IS RADICAL PROSTATECTOMY THE MOST COMMON CAUSE IS RADICAL PROSTATECTOMY (between 6 and 60 % with a mean of 14%)

4. THERAPEUTIC DEVICES THERAPEUTIC DEVICES REEMEX REEMEX ARGUS ARGUS PRO-ACT PRO-ACT ARTIFICIAL SPHINCTER AMS 800 ARTIFICIAL SPHINCTER AMS 800 ARTIFICIAL SPHINCTER FLOWSECURE ARTIFICIAL SPHINCTER FLOWSECURE ADVANCE ADVANCE ATOMS ATOMS

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12. ATOMS SYSTEM: INDICATIONS RADICAL PROSTATECTOMY WITH OR WITHOUT RADIOTHERAPY. RADICAL PROSTATECTOMY WITH OR WITHOUT RADIOTHERAPY. RETROPUBIC ADENOMECTOMY. RETROPUBIC ADENOMECTOMY. TURP OR MIST PROSTATIC TURP OR MIST PROSTATIC

13. ATOMS SYSTEM: PREOPERATIVE SONOGRAPHY. SONOGRAPHY. CYSTOGRAPHY. CYSTOGRAPHY. FLOWMETER. FLOWMETER. URETHROCYSTOSCOPY. URETHROCYSTOSCOPY. ¿ URODYNAMIC STUDY ? ¿ URODYNAMIC STUDY ?

14. ATOMS SYSTEM: CONTRAINDICATIONS. RESIDUAL URINE. RESIDUAL URINE. RECURRENT URINARY TRACT INFECTIONS. RECURRENT URINARY TRACT INFECTIONS. URINARY FISTULA. URINARY FISTULA. IMMUNOSUPPRESSION. IMMUNOSUPPRESSION.

15. ATOMS SYSTEM: CASUISTRY OPERATE: 51 PATIENTS. 45 RADICAL PROSTATECTOMY (14 TREATMENT OF RADIOTHERAPY ADJUVANT ). 2 RETROPUBIC ADENOMECTOMY 1 PROSTATE LASER 3 TUR PROSTATE

18. ATOMS SYSTEM: INCONTINENCE RANK. 33 SEVERE INCONTINENCE( + 3 pads daily). 33 SEVERE INCONTINENCE( + 3 pads daily). 16 MODERATE INCONTINENCE (1-3 pads daily). 16 MODERATE INCONTINENCE (1-3 pads daily). 2 MILD INCONTINENCE. 2 MILD INCONTINENCE.

19. ATOMS SYSTEM MEAN AGE:68 YEARS MEAN AGE:68 YEARS AVERAGE SURGICAL TIME: 55 MINUTES AVERAGE SURGICAL TIME: 55 MINUTES FOLLOW-UP: 24 MONTHS FOLLOW-UP: 24 MONTHS AVERAGE FILLING PORT:18cc (CAPACITY 27cc.) AVERAGE FILLING PORT:18cc (CAPACITY 27cc.) 17 % (9 PATIENTS) NO FILLING OUTPATIENT 17 % (9 PATIENTS) NO FILLING OUTPATIENT

22. ATOMS SYSTEM: RESULTS. 85% TOTALLY DRY, NO ABSORBENT NEEDED (INCLUDING SEVERE INCONTINENCE) 85% TOTALLY DRY, NO ABSORBENT NEEDED (INCLUDING SEVERE INCONTINENCE) 11% GREAT IMPROVEMENT INCONTINENCE ( 1 PAD DAILY). 11% GREAT IMPROVEMENT INCONTINENCE ( 1 PAD DAILY). 4 % WITH MINOR IMPROVEMENT. 4 % WITH MINOR IMPROVEMENT.

23. PORT POSITION PORT POSITION ABDOMINAL: 37 PATIENTS (73%) ABDOMINAL: 37 PATIENTS (73%) SCROTAL: 14 PATIENTS (27%) SCROTAL: 14 PATIENTS (27%)

26. ATOMS SYSTEM: COMPLICATIONS. 3 URINARY RETENTION (48 HOURS CATHETER). 3 URINARY RETENTION (48 HOURS CATHETER). 7 SURGICAL ABDOMINAL WOUND INFECTION, REMOVAL TITANIUM PORT. 7 SURGICAL ABDOMINAL WOUND INFECTION, REMOVAL TITANIUM PORT. 3 FULL SYSTEM INFECTIONS 3 FULL SYSTEM INFECTIONS 1 TESTICULAR PAIN 2 MONTHS (EPIDIDYMITIS) 1 TESTICULAR PAIN 2 MONTHS (EPIDIDYMITIS)

27. ATOMS SYSTEM: ADVANTAGES MINIMALLY INVASIVE SURGERY MINIMALLY INVASIVE SURGERY REPRODUCIBLE REPRODUCIBLE SUBURETHRAL CONSTANT PRESSURE DISTRIBUTION SUBURETHRAL CONSTANT PRESSURE DISTRIBUTION POSTOPERATIVELY READJUSTABLE POSTOPERATIVELY READJUSTABLE EFFECTIVE FOR ALL GRADES OF INCONTINENCE EFFECTIVE FOR ALL GRADES OF INCONTINENCE IDEAL FOR RADIATED PATIENTS IDEAL FOR RADIATED PATIENTS PHYSIOLOGICAL URINATION WITHOUT NEED FOR MECHANICAL HANDLING PHYSIOLOGICAL URINATION WITHOUT NEED FOR MECHANICAL HANDLING