Decision satisfaction and regret in patients undergoing ATOMS® adjustable sling for male urinary stress incontinence: data from a third level referral centre

Purpose: The study aimed to evaluate treatment satisfaction and decisional regret in patients who underwent Adjustable Trans-Obturator Male System (ATOMS (R)) implantation for stress urinary incontinence (SUI). Methods: This retrospective, observational, single-arm cohort study reviewed records of 134 patients who underwent ATOMS implantation between January 2014 and December 2021. Data collected included demographics, pre- and post-operative continence status, complications classified by Clavien-Dindo, and patient-reported outcomes using the International Consultation on Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI SF). Decisional regret was assessed using the validated Decision Regret Scale (DRS). Predictors of regret were analyzed using univariate and multivariate logistic regression. Results: Patients had a median age of 72 years, with 30% reporting moderate/severe regret (> 25%). Regret was significantly associated with prior radiotherapy, diabetes, higher preoperative pad usage, and worse postoperative ICIQ-UI SF scores. Multivariate analysis identified radiotherapy (OR = 3.09; p = 0.049) and preoperative ICIq score (1.49; p = 0.001) as independent predictors of regret. When considering postoperative data, the only independent predictor of regret is the number of pads (OR = 5.58; p = 0.001). Conclusion: ATOMS implantation provides good objective outcomes; however, some of the patients may present some regret. Preoperative radiotherapy and preoperative continence status are key predictors of regret. These findings highlight the importance of tailored preoperative counseling to manage patient expectations and improve.