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This study confirms ATOMS device is safe and achieves high treatment efficacy and patient satisfaction in a multicenter setting. Significantly better results are achieved in less severe and non-irradiated cases. Durability of the device is reassuring in the short-term.

Objectives: Feasibility study to evaluate the efficacy and safety of Adjustable Transobturator Male System (ATOMS) after failed surgical devices for male stress urinary incontinence (SUI). Materials and Methods: Thirty patients were implanted with ATOMS after they were implanted with surgical device/s previously. SUI severity was evaluated as dryness (0–1 pad/day), mild (2 pads/day), moderate (3–5 pads/day), or severe (≥6 pads/day). Change in pad-test and pad-count after adjustment, operative parameters, patient satisfaction, and number and grade of complications were investigated. Results: Previous failed treatment methods were artificial urinary sphincter (AUS; n = 19), Advance (n = 10), and Virtue (n = 1). Six cases had multiple previous treatments. Preoperative SUI was mild 6 (20%), moderate 11 (36.7%), and severe 13 (43.3%). Median pad-test decreased from 435 mL baseline to 10 mL after adjustment and pad-count from 4 to 0. Dry-rate was 76.7 and 83.3% declared satisfied. Postoperative SUI distribution was mild in 3 (10%) and moderate in 4 (13.3%). No patient had urinary retention after catheter removal. Complications presented in 4 (13.3%; 3 grade-I, 1 grade-II). After a median of 24 months follow-up, no system experienced infection or urethral erosion and 1 (3.3%) was removed for inefficacy. Conclusion: Based on short-term efficacy and patient satisfaction, ATOMS can be a realistic alternative for male SUI after other failed systems, including AUS. The absence of urethral erosion and limited infective problems makes this alternative attractive for cases with previous failed treatments.

Introduction: Renal cell carcinoma (RCC) reveals a tendency towards venous invasion in its advanced stages, making clinical management challenging. Survival may be improved following surgery, but is less clear if it applies to patients with metastatic disease at diagnosis. Materials and Methods: Review of clinical files of patients submitted to surgery for RCC at our institution. Results: Twenty-one patients underwent radical nephrectomy and thrombectomy from 2000 to 2017, with a median follow-up of 25 months. Eighteen (85.7%) men and 3 (14.3%) women, with median age of 63 at the time of diagnosis, were included. The thrombus was in the renal vein in 10 (47.6%) patients and had extension to inferior vena cava (IVC) in 11 (52.4%). The level of involvement in IVC was grade II in 4 (19%) cases, grade III in 4 (19%) cases and grade IV in 3 (14.4%) cases. Surgery was successful in all but 1 patient. Ten patients died during the follow-up (47.6%), resulting in a 5-year overall survival of 34.8%. When considering the metastatic population at diagnosis, the overall survival at 5 years was 45.7%. Conclusion: Radical nephrectomy with removal of the venous thrombus remains the preferential treatment for patients with RCC with venous thrombus, even if they have metastatic disease at diagnosis.

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