In a systematic review and meta-analysis, Esquinas and Angulo (2019) examined the effectiveness of the Adjustable Transobturator Male System (ATOMS) device to treat male SUI. Two independent reviewers identified studies eligible for a systematic review and meta-analysis of various sources written in English, German and Spanish, using the databases PubMed, Embase and Web of Science. They excluded studies on female incontinence. These researchers employed the DerSimonian and Laird method for defining heterogeneity, calculating the grouped SMD. The primary objective of this review was the evaluation of clinical efficacy based on the achievement of dryness following device adjustment, defined as use of no pad or 1 safety pad per day (PPD). The secondary objective was focused on analyzing improvement of incontinence with the device. Magnitude of effect was calculated by analyzing decrease in PPD and/or in 24-hour pad test. Number and severity of complications according to Clavien-Dindo classification were also reviewed. The pooled data of 1,393 patients from 20 studies (13 retrospective and 7 prospective) showed that treatment with ATOMS resulted in a mean 67 % dryness rate and 90 % improvement after adjustment. Mean total number of system fillings per patient was 2.4. Mean pad count and 24-hour pad test decrease were - 4.14 PPD and - 443 cc, respectively. There was significant heterogeneity of the sample analyzed, mainly based on variable baseline severity of incontinence, proportion of patients treated with irradiation and different generation devices. Proportion of irradiated patients affected dryness rate (p = 0.0014), together with baseline severity of incontinence (p = 0.0035) and different generation device used (p < 0.0001). Standardized mean follow-up was 20.9 months, with complications occurring in 16.4 % (major complications 3.0% ) and explantation in 5.75 %. No randomized study has been developed so far to compare ATOMS to other devices for treating male SUI. The authors concluded that despite the evidence being exclusively based on descriptive studies and limited follow-up, ATOMS has proven to be a safe alternative to treat different degrees of male SUI following prostate surgery; better results were observed for patients with less than 6 PPD before implantation, non-irradiated patients and use of 3rd-generation device with silicone-covered pre-attached scrotal port. These researchers stated that ATOMS appeared to be a safe and effective procedure, with pooled data showing high objective effectiveness and low rate of complications in the short- and medium-term. They noted that it would be of great interest to develop comparative prospective studies in the future among ATOMS and other devices, not only regarding effectiveness but also including patient-reported outcomes.