Surgical Treatment of Prostate Cancer: Case Report of Simultaneous Penile Prosthesis and Artificial Urinary Sphincter Implantation Following ATOMS Removal

The surgical management of prostate cancer has evolved significantly. Despite minimally invasive techniques, the incidence of erectile dysfunction (ED) ranges from 25–75%, and stress urinary incontinence (SUI) occurs in 0–11% of patients at one year. SUI is classified according to severity as follows: mild <100 g/24 h, moderate 100–400 g/24 h, and severe >400 g/24 h.

The ATOMS (Adjustable Transobturator Male System) is indicated for mild to moderate SUI. In cases of severe SUI and/or significant sphincter insufficiency, the preferred intervention is an artificial urinary sphincter (AUS).

MATERIALS AND METHODS:
A 70-year-old male with a history of laparoscopic radical prostatectomy (pT2c, G7 [3+4]) presented with refractory ED and mild-to-moderate SUI. An ATOMS device was initially implanted, but the patient experienced a complicated postoperative course; the reservoir was subsequently removed, preserving the connecting cable and cushion.

Due to persistent, limiting pain at the base of the penis, groin, perineum, and left gluteal region, the remaining ATOMS components were explanted with a view to simultaneous implantation of an AUS and penile prosthesis for refractory ED, with IPD5 and PG considerations.Surgical Technique:

ATOMS removal: Lithotomy position, perineal incision, dissection to expose the ATOMS device, opening of the capsule, transection of both branches, and removal of the cushion and connections. Closure.
AUS and Penile Prosthesis Implantation: Low lithotomy position, penoscrotal incision, identification and exposure of the bulbospongiosus muscle, dissection of the bulbar urethra, measurement of urethral caliber, preparation and priming of the AUS, placement of the cuff, and approximation of the bulbospongiosus muscle. Dissection to expose the corpora cavernosa, placement of four absorbable sutures, longitudinal corporotomy, creation of intracavernosal tract and dilation, measurement of the corpora, preparation and priming of prosthetic components, insertion of intracavernosal cylinders, closure of corporotomy, and verification of prosthesis function. Dissection and opening of the right suprapubic space with access to the retropubic (Retzius) space using a rhinoscope, placement of the reservoir lateral to the bladder, creation of a midline scrotal pocket, and placement of the pump. Priming and connection of the hydraulic circuit. Dissection and opening of the left suprapubic space, placement of the AUS reservoir balloon in the retropubic space, creation of the left scrotal pocket, and placement of the pump. Connection of the AUS hydraulic system via the suprapubic incision. Closure of the external oblique fascia and skin. Verification of sphincter function, deactivation, placement of drainage, partial activation of the penile prosthesis, closure of Dartos and skin, and application of a compressive dressing

•	ATOMS removal: 45 min 
•	AUS and prosthesis implantation: 170 min 
•	Blood loss: negligible 
•	Hospital stay: 48 h 
•	Outcome: patient continent, prosthesis functional, satisfied, infection-free 
Conclusions:

Simultaneous penile prosthesis and AUS implantation is safe, feasible, and significantly improves quality of life in patients with refractory ED and SUI following ATOMS failure

Continence 19S (2026) 102735
DOI: 10.1016/j.cont.2026.102735