{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:31:56Z","timestamp":1787027516538,"version":"build-2736575974"},"reference-count":31,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate and compare the feasibility, safety, and efficacy of the classic and a novel, proximal implantation technique of the Adjustable Transobturator Male System (ATOMS) in patients with severe Post\u2010Prostatectomy\u2010Incontinence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>This retrospective cohort comprised 131 male patients who received ATOMS implants for severe PPI between November 2018 and May 2024. The classic, distal technique was applied up to July 2021, after which the proximal technique was exclusively adopted. Baseline data, intraoperative details, and postoperative results were documented. Follow\u2010up was obtained cross\u2010sectionally in November 2024, covering continence outcomes and patient satisfaction using validated questionnaires.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Baseline characteristics were comparable between groups. The proximal technique required greater initial cushion\u2010filling volume but fewer postoperative adjustments. Early continence outcomes were similar, with both groups achieving a median of 1.0 pad\/day and a full continence rate of 54.0%. At follow\u2010up, the proximal cohort demonstrated superior functional results, including higher complete continence rates (64.6% vs. 38.1%) and greater patient satisfaction. Patients in the proximal group reported lower ICIQ\u2010SF scores and a higher likelihood of recommending the procedure. Postoperative urgency was less frequent. Although residual urine occurred more often with proximal implantation, rates of urinary retention, surgical complications, and explantation did not differ.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The proximal technique offers good long\u2010term continence outcomes, higher patient satisfaction, and fewer urgency symptoms while maintaining a comparable complication profile. Short\u2010 and long\u2010term results seem superior to the classic method, though interpretation of long\u2010term data is limited by unequal follow\u2010up durations. Overall, our findings support the proximal approach as the preferred method for ATOMS implantation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.70333","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:31:43Z","timestamp":1780486303000},"page":"1343-1350","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unraveling the Knot: The Impact of Distal vs. Proximal Implantation Technique on Adjustable Transobturator Male Sling (ATOMS) Outcomes for the Treatment of Stress Urinary Incontinence"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3053-944X","authenticated-orcid":false,"given":"Leo F.","family":"Stadelmeier","sequence":"first","affiliation":[{"name":"Department of Urology University Hospital of Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Lederer","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2072-5521","authenticated-orcid":false,"given":"Marc","family":"Kidess","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troya","family":"Georgieva","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Hermans","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Happe","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Keller","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Tamalunas","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Puhr\u2010Westerheide","sequence":"additional","affiliation":[{"name":"Department of Radiology University Hospital of Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Queissert","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Munster Munster Nort Rhine\u2010Westphalia Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricarda","family":"Bauer","sequence":"additional","affiliation":[{"name":"Urologie Maximilianstrasse Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian G.","family":"Stief","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-9398","authenticated-orcid":false,"given":"Yannic","family":"Volz","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"EAU Guidelines. 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