Abstract Introduction Urinary incontinence and erectile dysfunction are both common conditions, often underdiagnosed due to patients’ reluctance to seek medical attention. They have a major personal and social impact on quality of life. Proper management requires identifying the underlying cause or type, as both conditions may share or stem from a common pathological process. Objective To describe the management of a 66-year-old male with simultaneous stress urinary incontinence and erectile dysfunction, treated with a combined ATOMS system and a three-component penile prosthesis. Methods A 66-year-old male with a history of prostate adenocarcinoma, Gleason score 3+4 (7/10), treated with extraperitoneal laparoscopic radical prostatectomy in September 2020, followed by adjuvant radiotherapy to the prostate bed from September 2021 to January 2022. PSA levels remained stable between 0.04–0.08 ng/mL. He presented with total erectile dysfunction and stress urinary incontinence. Cystoscopy showed a competent sphincter and normal urethra and bladder. Urodynamic studies ruled out detrusor overactivity and obstruction. Pad test: 250 g; ICIQ-SF: 4+2+5. Moderate stress urinary incontinence was observed at 230 cc, with pAbd of 145 cmH₂O. Painful, poorly tolerated erections were noted with Caverject, and penile curvature of 30° to the left. The patient therefore underwent simultaneous implantation of an ATOMS system and a three-component penile prosthesis through an infrapubic approach. Results The procedure was uneventful, and the patient was discharged with subsequent clinical improvement observed during follow-up. Conclusions The ATOMS implant has proven to be a safe and effective option for the treatment of post-prostatectomy stress urinary incontinence, providing significant symptomatic improvement. Although typically considered a later-line treatment for erectile dysfunction, the penile prosthesis remains a highly effective solution in patients who do not respond to less invasive therapies. Disclosure No
Teyrouz et al. (2026) studied this question.