Clinical bottom line
Novel therapies for male stress urinary incontinence (SUI) post-prostatectomy, including adjustable slings such as the Adjustable Transobturator Male System (ATOMS) and the Virtue® sling, demonstrate promising efficacy and safety profiles. These devices offer less invasive alternatives to artificial urinary sphincters (AUS) with favorable continence outcomes and manageable complication rates. However, patient selection, surgical technique, and long-term durability remain critical considerations. Current evidence supports these options as valuable additions to the therapeutic armamentarium, especially for patients with mild to moderate SUI (Bajaj et al., 2024; Stadelmeier et al., 2026).
What the evidence shows
The ATOMS device has gained increasing attention due to its adjustability and minimally invasive implantation. Bajaj et al. (2024) report accumulating evidence demonstrating significant improvement in continence rates, with dry rates ranging from 60% to 80% in various cohorts. The adjustability allows postoperative tension modification, enhancing patient-tailored outcomes. Stadelmeier et al. (2026) further elucidate that proximal implantation techniques may improve functional results compared to distal approaches, emphasizing the impact of surgical expertise.
The Virtue® sling, a quadruply anchored polypropylene mesh, has shown encouraging results in reducing pad usage and improving quality of life. Dockray et al. (2017) describe favorable continence outcomes with low complication rates, though longer-term data are limited.
Artificial urinary sphincters remain the gold standard for severe SUI, with established efficacy but higher invasiveness and potential device-related complications (Chartier-Kastler et al., 2021; Reus et al., 2019). Adjustable slings may fill the treatment gap for patients unsuitable or unwilling to undergo AUS implantation.
Physiotherapy and pelvic floor rehabilitation continue to play adjunctive roles, particularly in early postoperative management (Soto-González et al., 2017).
Caveats and uncertainty
Most studies on novel slings are observational or single-center series with limited randomized controlled trial data. Variability in patient selection criteria, follow-up duration, and outcome definitions complicate direct comparisons.
Long-term durability and device-related adverse events such as erosion or infection require further surveillance.
Optimal timing for intervention post-prostatectomy and integration with conservative therapies remain areas of ongoing investigation.
Comparative effectiveness studies between adjustable slings and AUS in diverse populations are needed to refine treatment algorithms.
How this may change practice
Adjustable male slings like ATOMS and Virtue® offer effective, less invasive options for managing post-prostatectomy SUI, potentially expanding treatment access and patient choice.
Surgeons should consider individual patient factors including incontinence severity, prior radiation, and manual dexterity when selecting devices.
Refinement of surgical techniques, informed by emerging evidence such as the impact of implantation site, may optimize outcomes.
Multidisciplinary care incorporating physiotherapy and patient education remains essential.
Future guideline updates may incorporate these novel therapies as standard options alongside AUS.