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Bajaj M, Frampton C, Losco G, Westenberg A. Adjustable transobturator male system (ATOMS) for stress urinary incontinence: the evidence is mounting. BJU Int 2024; 133 Suppl 3:33-38. [PMID: 37409820 DOI: 10.1111/bju.16118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVES To evaluate the New Zealand clinical experience with the adjustable transobturator male system (ATOMS), a novel continence device in the management of all degrees of stress urinary incontinence (SUI), focusing on efficacy and safety outcomes. PATIENTS AND METHODS A retrospective review of all ATOMS devices placed between May 2015 and November 2020 was conducted. Severity of SUI was assessed (pad usage) before and after surgery. SUI was defined as mild (1-<3 pads/day), moderate (≥3-5 pads/day) or severe (>5 pads/day). The primary outcome measures considered were the overall success rate (improvement in pad use) and the dry rate (with dry defined as either no or 1 safety pad/day). The number of outpatient adjustments and total filling volumes were also documented in each case. Additionally, we documented incidence and severity of device complications and an analysis of treatment failures. RESULTS A total of 140 patients were reviewed, with the most common indication for ATOMS placement being SUI after radical prostatectomy (82.8%). Of the patients included, 53 (37.9%) had previous radiotherapy, with 26 (18.6%) patients having had a previous continence procedure performed. No intraoperative complications were noted. The median preoperative pad usage was 4 pads/day. After a median follow-up of 11 months, median postoperative pad usage reduced to 1 pad/day. In our cohort, 116 patients (82.9%) reported an improvement in their pad usage and were considered successful with 107 (76.4%) patients reporting themselves to be dry. Complications within the first 90-days after surgery occurred in 20 (14.3%) of patients. CONCLUSION Treatment of SUI with the ATOMS is safe and effective. The option of long-term, minimally invasive adjustment to respond to patient needs is a significant advantage.
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Affiliation(s)
| | - Chris Frampton
- Statistics Department, University of Otago, Dunedin, New Zealand
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Rojas Cruz C, Hakenberg O, Dräger DL. [Use of implants to treat male urinary incontinence]. Aktuelle Urol 2023; 54:449-456. [PMID: 37748511 DOI: 10.1055/a-2108-7615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Treatments for benign and malignant pathologies of the prostate can compromise urine control. Urinary incontinence (UI) affects the quality of life of patients and limits their ability to carry out usual activities. The degree of impact of UI is variable and the associated discomforts make patients seek treatment for it. At the center of the management of urinary incontinence in men are surgical interventions that seek to replace the affected sphincter function through implants. The artificial urinary sphincter since its development in the 1970s has been considered the standard of treatment for UI in men. More recently artificial sphincter and slings have been shown to be effective in a selected group of incontinent men. The goals of surgical treatment of incontinence include the preservation of bladder function, the ability to improve the strength of the urinary sphincter, and to reduce or eliminate urine leakage, and thereby improve the quality of life. The aim of the article is to present various implants for the correction of male urinary incontinence.
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Chung E. Contemporary male slings for stress urinary incontinence: advances in device technology and refinements in surgical techniques. Ther Adv Urol 2023; 15:17562872231187199. [PMID: 37528956 PMCID: PMC10387683 DOI: 10.1177/17562872231187199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/19/2023] [Indexed: 08/03/2023] Open
Abstract
Synthetic male sling (MS) is considered an effective surgical treatment to restore male stress urinary incontinence. The modern MS can be categorised into adjustable or non-adjustable types, while the surgical techniques can be divided into retropubic or transobturator approaches. This narrative review paper evaluates the contemporary MS devices in the current commercial market regarding clinical outcomes and refinements in surgical techniques. Scientific advances in device design and technology, coupled with further surgical refinements will enhance the clinical outcomes and improve the safety profile of MS surgery. The newer generation of modern MS not only provides direct compression of the bulbar urethra but also allows for proximal urethral relocation by realigning the mobile sphincter complex to provide further urethral sphincter complex coaptation. Strict patient selection, use of MS with proven clinical records, adherence to safe surgical principles and judicious postoperative care are critical to ensure a high continence rate, good patient satisfaction and low postoperative complications.
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Comparison of Different Invasive Devices for the Treatment of Urinary Incontinence after Radical Prostatectomy. Adv Urol 2022; 2022:8736249. [PMID: 35774194 PMCID: PMC9239822 DOI: 10.1155/2022/8736249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare different forms of invasive treatments for postradical prostatectomy (RP) urinary incontinence (UI) in terms of quantitative and qualitative parameters and continence recovery rate. Methods We distinguished five categories of treatment: A = bulking agents, B = fixed slings, C = adjustable slings, D = circumferential compressor devices (artificial sphincter), and E = noncircumferential compressor devices (ProACT). A literature search was performed following the PRISMA guidelines. We performed a cumulative meta-analysis to explore the trend in the effect sizes across groups at postoperative follow-up. We compared the available treatment arms using standardized mean difference (SMD) and event rate (ER) for questionnaire results, number of pads/day, and percentage of pad-free patients. Evidence synthesis. 36 clinical trials were selected. At baseline, in the different populations, mean number of pad-day varied from 1.1 to 8.8, 24-hour pad weight varied extremely from 17.3 g to 747.0 g, and mean ICIQ-UI-SF questionnaire score varied from 4.8 to 18.6. Considering a random effect model among eligible studies, ER of continence recovery was 0.33 (95% CI −0.12–0.78), 0.63 (95% CI 0.55–0.71), 0.65 (95% CI 0.58–0.72), 0.50 (95% CI 0.34–0.66), and 0.53 (95%CI 0.36–0.70), respectively, in groups A, B, C, D, and E (I2 85.87%; Q 249.82—P > 0.01) (test of group differences P=0.22). Conclusion In our analysis, the use of adjustable and fixed slings is associated with the highest whereas the use of bulking agents is associated with the lowest recovery rate of continence after treatment. Results are conditioned by an elevated rate of heterogeneity in part explained with a high variability of consistence in urinary leakage at baseline among populations.
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Schmid FA, Williams JK, Kessler TM, Stenzl A, Aicher WK, Andersson KE, Eberli D. Treatment of Stress Urinary Incontinence with Muscle Stem Cells and Stem Cell Components: Chances, Challenges and Future Prospects. Int J Mol Sci 2021; 22:3981. [PMID: 33921532 PMCID: PMC8069473 DOI: 10.3390/ijms22083981] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 02/06/2023] Open
Abstract
Urinary incontinence (UI) is a major problem in health care and more than 400 million people worldwide suffer from involuntary loss of urine. With an increase in the aging population, UI is likely to become even more prominent over the next decades and the economic burden is substantial. Among the different subtypes of UI, stress urinary incontinence (SUI) is the most prevalent and focus of this review. The main underlying causes for SUI are pregnancy and childbirth, accidents with direct trauma to the pelvis or medical treatments that affect the pelvic floor, such as surgery or irradiation. Conservative approaches for the treatment of SUI are pelvic physiotherapy, behavioral and lifestyle changes, and the use of pessaries. Current surgical treatment options include slings, colposuspensions, bulking agents and artificial urinary sphincters. These treatments have limitations with effectiveness and bear the risk of long-term side effects. Furthermore, surgical options do not treat the underlying pathophysiological causes of SUI. Thus, there is an urgent need for alternative treatments, which are effective, minimally invasive and have only a limited risk for adverse effects. Regenerative medicine is an emerging field, focusing on the repair, replacement or regeneration of human tissues and organs using precursor cells and their components. This article critically reviews recent advances in the therapeutic strategies for the management of SUI and outlines future possibilities and challenges.
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Affiliation(s)
- Florian A. Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - J. Koudy Williams
- Institute of Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC 27101, USA; (J.K.W.); (K.-E.A.)
| | - Thomas M. Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland;
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tubingen, University of Tubingen, 72076 Tubingen, Germany; (A.S.); (W.K.A.)
| | - Wilhelm K. Aicher
- Department of Urology, University Hospital Tubingen, University of Tubingen, 72076 Tubingen, Germany; (A.S.); (W.K.A.)
| | - Karl-Erik Andersson
- Institute of Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC 27101, USA; (J.K.W.); (K.-E.A.)
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
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Angulo JC, Schönburg S, Giammò A, Queissert F, Gonsior A, González-Enguita C, Martins FE, Rourke K, Cruz F. Artificial urinary sphincter or a second adjustable transobturator male system offer equivalent outcomes in patients whom required revision on the initial ATOMS device: An international multi-institutional experience. Neurourol Urodyn 2021; 40:897-909. [PMID: 33645867 DOI: 10.1002/nau.24646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 11/11/2022]
Abstract
AIM To evaluate treatment options after surgical revision of adjustable transobturator male system (ATOMS) and the results of further incontinence implantation. MATERIALS AND METHODS A retrospective multicenter study evaluating patients with surgical revision of ATOMS in academic institutions. Causes and factors affecting revision-free interval were studied and also the frequency of device explant and placement of second ATOMS or artificial urinary sphincter (AUS) at surgeon discretion. Operative results, complications (Clavien-Dindo), and efficacy (postoperative pad-test, pad-count, patient satisfaction, and patient global impression of improvement [PGI-I scale]) of each treatment option were compared. RESULTS Seventy-eight out of 902 patients (8.65%) with ATOMS underwent surgical revision at 4.1 ± 2.4 years mean follow-up and 75 (8.3%) were explanted. The main causes for revision included persistence of incontinence (35.9%) and scrotal port erosion (34.6%). Independent risk factors of the shortened revision-free interval were previous anti-incontinence surgery (HR, 1.83; 95% CI, 1.06-3.16; p = 0.007) and port erosion (HR, 1.83; 95% CI, 1.06-3.16; p = 0.0027). Fifty-eight (6.4%) received a second implant: 31 repeated ATOMS and 27 AUS. Operative time was longer for AUS (p = .003). The visual analog scale of pain at hospital discharge (p = 0.837) and postoperative complications (p = 0.154) were equivalent. The predominant cuff size for AUS was 4.5 cm (59.3%). Mean follow-up after the second implant was 29.1 ± 25.8 months. Postoperative efficacy of secondary treatment results favored ATOMS based on pad-test (p = 0.016), pad-count (p = 0.029), patient satisfaction (p = 0.04), and PGI-I (p = 0.025). CONCLUSIONS ATOMS surgical revision due to different reasons generally leads to device explant. Rescue treatment is possible with ATOMS or AUS. No difference in postoperative complications was detected between secondary devices, but efficacy favors repeating ATOMS implantation.
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Affiliation(s)
- Javier C Angulo
- Clinical Department, Universidad Europea de Madrid, Hospital Universitario de Getafe, Madrid, Spain
| | - Sandra Schönburg
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany
| | - Alessandro Giammò
- Department of Neuro-Urology, CTO/Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabian Queissert
- Department of Urology, Universitätsklinikum Münster, Münster, Germany
| | - Andreas Gonsior
- Klinik und Poliklinik für Urologie, University of Leipzig, Leipzig, Germany
| | | | - Francisco E Martins
- Centro Hospitalar Universitário de Lisboa Norte, Hospital Santa María, Lisboa, Portugal
| | - Keith Rourke
- Department of Urology, Alberta University, Edmonton, Alberta, Canada
| | - Francisco Cruz
- Department of Urology, Centro Hospitalar São João, Oporto, Portugal
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Giammò A, Ammirati E, Tullio A, Morgia G, Sandri S, Introini C, Canepa G, Timossi L, Rossi C, Mozzi C, Carone R. Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: an Italian multicentric study. MINERVA UROL NEFROL 2020; 72:770-777. [DOI: 10.23736/s0393-2249.19.03457-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Odabaş Ö, Gül Sancak I, Kasap Y, Mahmut Z, Ölçücüoğlu E, Taştemur S, Zengin N. A novel urethra compression technique using Turkish continence device for male urinary incontinence. Turk J Med Sci 2020; 50:1210-1216. [PMID: 32151120 PMCID: PMC7491266 DOI: 10.3906/sag-1907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 03/05/2020] [Indexed: 11/05/2022] Open
Abstract
Background/aim The male sling operation and artificial urinary sphincter implantation are common methods for treating urinary incontinence. However, there are some drawbacks to these methods such as infection, urethral erosion, pain, inefficiency, and the technical difficulty of the operations. Here we describe a new device we have named the Turkish Continence Device (TCD) which has advantages over these other methods. The aim of this study was perform experiments with the TCD prototype in vivo and ex vivo to determine efficiency, convenience of implantation, and negative effects. Materials and methods We implanted the prototype device in male goats and sheep, compressing the posterior urethra, and then fixed it by sutures on the lateral sides of the cavernosal bodies, bilaterally. Then we recorded urodynamic findings and performed urinary imaging. Additionally we measured urethral closure pressure ex vivo. Results The balloon volume for efficient urethral closure pressure using the new device was under 1 mL. It compressed the urethra towards the corpus cavernosum perfectly, because the wings of the prototype device are fixed near the tunica of the cavernosal bodies on each side. Conclusion A smaller device with smaller arms/wings would be efficient for obtaining enough pressure on the urethra. Additionally, the technique for implanting the device is very simple and would likely be learned quickly.
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Affiliation(s)
- Öner Odabaş
- Urology Clinic, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
| | - Irem Gül Sancak
- Surgery Department, Faculty of Veterinary Medicine, Ankara University, Ankara, Turkey
| | - Yusuf Kasap
- Urology Clinic, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
| | - Zerrin Mahmut
- Surgery Department, Faculty of Veterinary Medicine, Ankara University, Ankara, Turkey
| | - Erkan Ölçücüoğlu
- Urology Clinic, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
| | - Sedat Taştemur
- Urology Clinic, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
| | - Neslihan Zengin
- Pathology Laboratory,Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
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9
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Angulo JC, Ruiz S, Lozano M, Arance I, Virseda M, Lora D. Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and male Readjustment Mechanical External (REMEEX) system for post-prostatectomy incontinence. World J Urol 2020; 39:1083-1092. [PMID: 32529450 DOI: 10.1007/s00345-020-03300-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/03/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of Adjustable Transobturator Male System (ATOMS) compared to male Readjustment Mechanical External (REMEEX) system for post-prostatectomy incontinence (PPI). MATERIAL AND METHODS A systematic review and meta-analysis on adjustable device ATOMS compared to male REMEEX is presented. Studies on female or neurogenic incontinence were excluded. Primary objectives were evaluation of dryness (the proportion of patients with no-pad or one safety pad/day after device adjustment) and improvement between devices. Secondary objectives were complications and explant rate. They were estimated using a random-effect model. Statistical heterogeneity among studies was assessed using Cochran's Q test, Higgins's I2 statistics and tau2. RESULTS Combined data of 29 observational studies with 1919 patients showed an equivalent proportion of patients treated with radical prostatectomy (p = .125) and previous radiation (p = .126). Dryness rate was 69.3% for ATOMS and 53.4% for male REEMEX (p = .008). Improvement rate was 90.8% for ATOMS and 80.2% for REMEEX (p = .007). Complication rate was 18.9% for ATOMS and 35.8% for REMEEX (p = .096) and explant rate was 5.5% for ATOMS and 13.9% for REMEEX (p = .027). Significant heterogeneity was evidenced, due to absence of randomized studies, variable incontinence severity baseline, difficulties for a common reporting of complications and difference in the follow-up. Differences observed between devices remained statistically significant when only studies with silicone-covered scrotal port (SSP) ATOMS and male REMEEX system II were considered. CONCLUSIONS Despite the absence of direct comparison and the limitations observed ATOMS appears more effective than male REMEEX to treat PPI, and with less explant rate as reported in the literature.
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Affiliation(s)
- Javier C Angulo
- Departamento Clínico, Universidad Europea de Madrid, Madrid, Spain. .,Servicio de Urología, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, 28905, Madrid, Spain.
| | - Sonia Ruiz
- Departamento Clínico, Universidad Europea de Madrid, Madrid, Spain.,Servicio de Urología, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, 28905, Madrid, Spain
| | - Martín Lozano
- Departamento Clínico, Universidad Europea de Madrid, Madrid, Spain.,Servicio de Urología, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, 28905, Madrid, Spain
| | - Ignacio Arance
- Departamento Clínico, Universidad Europea de Madrid, Madrid, Spain.,Servicio de Urología, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, 28905, Madrid, Spain
| | - Miguel Virseda
- Departamento Clínico, Universidad Europea de Madrid, Madrid, Spain.,Servicio de Urología, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, 28905, Madrid, Spain
| | - David Lora
- Instituto de Investigación Sanitaria Hospital "12 de Octubre" (i+12), CIBER de Epidemiología y Salud Pública (CIBERESP), Universidad Complutense de Madrid, 28041, Madrid, Spain
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10
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Angulo JC, Virseda‐Chamorro M, Arance I, Ruiz S, Ojea A, Carballo M, Rodríguez A, Pereira J, Teyrouz A, Rebassa M, Escribano G, Teba F, Celada G, Madurga B, Martins FE, Mendes PA, Cruz F. Long‐term outcome of adjustable transobturator male system for stress urinary incontinence in the Iberian multicentre study. Neurourol Urodyn 2020; 39:1737-1745. [DOI: 10.1002/nau.24410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/01/2020] [Accepted: 05/17/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Javier C. Angulo
- Department of Urology, Hospital Universitario de GetafeUniversidad Europea de MadridMadrid Spain
| | - Miguel Virseda‐Chamorro
- Department of Urology, Hospital Universitario de GetafeUniversidad Europea de MadridMadrid Spain
| | - Ignacio Arance
- Department of Urology, Hospital Universitario de GetafeUniversidad Europea de MadridMadrid Spain
| | - Sonia Ruiz
- Department of Urology, Hospital Universitario de GetafeUniversidad Europea de MadridMadrid Spain
| | - Antonio Ojea
- Department of UrologyHospital Alvaro CunqueiroVigo Spain
| | | | | | - Javier Pereira
- Department of UrologyHospital Arquitecto MarcideFerrol Spain
| | - Antoine Teyrouz
- Department of UrologyHospital Son LlatzerPalma de Mallorca Spain
| | - Miguel Rebassa
- Department of UrologyHospital Son LlatzerPalma de Mallorca Spain
| | - Gregorio Escribano
- Department of UrologyHospital Universitario Gregorio MarañónMadrid Spain
| | - Fernando Teba
- Department of UrologyHospital Universitario de la PrincesaMadrid Spain
| | - Guillermo Celada
- Department of UrologyHospital Universitario de la PrincesaMadrid Spain
| | - Blanca Madurga
- Department of UrologyHospital Universitario Puerta del MarCádiz Spain
| | | | - Pedro A. Mendes
- Department of UrologyCentro Hospitalar São JoãoOporto Portugal
| | - Francisco Cruz
- Department of UrologyCentro Hospitalar São JoãoOporto Portugal
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11
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Hüsch T, Kretschmer A, Obaje A, Kirschner-Hermanns R, Anding R, Pottek T, Rose A, Olianas R, Friedl A, Homberg R, Pfitzenmaier J, Abdunnur R, Queissert F, Naumann CM, Schweiger J, Wotzka C, Nyarangi-Dix J, Hofmann T, Ulm K, Hübner W, Bauer RM, Haferkamp A. Fixed or adjustable sling in the treatment of male stress urinary incontinence: results from a large cohort study. Transl Androl Urol 2020; 9:1099-1107. [PMID: 32676393 PMCID: PMC7354336 DOI: 10.21037/tau-19-852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Fixed and adjustable male slings for the treatment of male urinary stress incontinence became increasingly popular during the last decade. Although fixed slings are recommended for the treatment of mild to moderate stress urinary incontinence, there is still a lack of evidence regarding the precise indication for an adjustable male sling. Furthermore, there is still no evidence that one type of male sling is superior to another. However, both, adjustable and fixed slings, are commonly utilized in daily clinical practice. This current investigation aims to evaluate the differences between fixed and adjustable male slings regarding indications, complication rates and functional outcome in the treatment of male stress urinary incontinence in current clinical practice. Methods A total of 294 patients with a fixed and 176 patients with an adjustable male sling were evaluated in a multicenter single arm cohort trial. Data collection was performed retrospectively according the medical record. Functional outcome was prospectively analyzed by standardized, validated questionnaires. Descriptive statistics was performed to present patient characteristics, complication rates and functional outcome. A chi2-test for categorical and independent t-test for continuous variables was performed to identify heterogeneity between the groups and to correlate preoperative characteristics with the outcome. A P value <0.05 was considered statistically significant. Results Patients with higher degree of urinary incontinence (P<0.001) and risk factors such as history of pelvic irradiation (P<0.001) or prior surgery for urethral stricture (P=0.032) were more likely to receive an adjustable MS. Complication rates were comparable except for infection (P=0.009, 0 vs. 2.3%) and pain (P=0.001, 1.7% vs. 11.3%) which occurred more frequently in adjustable slings. Functional outcome according validated questionnaires demonstrated no differences between fixed and adjustable male slings. Conclusions Adjustable male slings are more frequently utilized in patients with higher degree of incontinence and risk factors compared to fixed slings. No differences could be identified between functional outcome which may imply an advantage for adjustability. However, pain and infection rates were significantly higher in adjustable MS and should be considered in the decision process for sling type.
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Affiliation(s)
- Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.,Promedon GmbH, Clinical Research, Kolbermoor, Germany
| | - Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.,Vancouver Prostate Center, University of British Columbia, Vancouver, Canada
| | - Alice Obaje
- Department of Urology, St. Bernward Hospital Hildesheim, Hildesheim, Germany
| | | | - Ralf Anding
- Neuro-Urology/Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Tobias Pottek
- Reconstructive Urology, Vivantes Hospital, Berlin, Germany
| | - Achim Rose
- Department of Urology and Pediatric Urology, Helios Hospital Duisburg, Duisburg, Germany
| | | | - Alexander Friedl
- Department of Urology, Merciful Sisters Hospital, Vienna, Austria
| | - Roland Homberg
- Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
| | | | - Rudi Abdunnur
- Department of Urology and Pediatric Urology, Helios Hospital Schwelm, Schwelm, Germany
| | - Fabian Queissert
- Department of Urology, University Hospital Muenster, Muenster, Deutschland
| | - Carsten M Naumann
- Department of Urology and Pediatric Urology, Marienhaus Hospital Neuwied, Neuwied, Germany
| | - Josef Schweiger
- Department of Urology and Pediatric Urology, Catholic Hospital St. Johann Nepomuk, Erfurt, Germany
| | - Carola Wotzka
- Department of Urology, Diakonie Hospital Stuttgart, Stuttgart, Germany
| | - Joanne Nyarangi-Dix
- Department of Urology and Pediatric Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Torben Hofmann
- Department of Urology, Diakonie Hospital Schwaebisch Hall, Schwaebisch Hall, Germany
| | - Kurt Ulm
- Institute of medical Statistic and Epidemiology, Technical University Munich, Munich, Germany
| | - Wilhelm Hübner
- Department of Urology, Hospital Weinviertel Korneuburg, Korneuburg, Austria
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
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12
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Schönburg S, Bauer W, Mohammed N, Brössner C, Fornara P. De novo OAB After ATOMS: An Underestimated Problem or a Rare Side Effect? Front Surg 2019; 6:72. [PMID: 31921886 PMCID: PMC6928117 DOI: 10.3389/fsurg.2019.00072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The urinary incontinence system ATOMS (A.M.I., Austria) generates suburethral compression through its sphincter cushion. To what extent the ATOMS may lead to overactive bladder (OAB) symptoms or which risk factors for these symptoms exist remain unknown to date. We report on our multicentre evaluation on the prevalence, status, and therapy of OAB after ATOMS. Methods: Between 10/09 and 01/17, a total of 361 patients received an ATOMS device in Vienna and Halle. A prerequisite for surgery was persistent male stress urinary incontinence lasting at least 6 months after the primary intervention, as well as the failure of conservative treatment. Patients with a preoperative untreated anastomotic stricture or detrusor overactivity were excluded. In addition to continence and voiding parameters, patient's age, BMI, comorbidities, and pre-treatment strategies of the underlying disease and urinary incontinence were examined. If de novo OAB was present, urodynamics were used for further clarification. Statistical analysis was performed with GraphPad Prism 7® (GraphPad Software, Inc., La Jolla, USA), p < 0.05 considered significant. Results: OAB presented 18 patients (4.9%). Regarding the degree of urinary incontinence as well as uroflowmetry, residual volume and comorbidities, patients with an OAB showed no differences compared to patients without an OAB (p < 0.05). Only previous radiotherapy or urinary incontinence surgery and urethral stricture interventions resulted in statistically significant differences based on the bivariate analysis (p = 0.030, p = 0.006, p = 0.007). The consecutive postoperative urodynamics revealed a sensory OAB in 17 patients and a low-compliance bladder in a patient with newly diagnosed insulin-dependent type II diabetes mellitus. OAB was treated with a standard dose of antimuscarinic drugs and for the low-compliance bladder with botulinum toxin type A. Conclusion: OAB symptoms can occur after ATOMS implantation, but are rare and have no clear correlation to the incontinence device but rather are due to urinary incontinence-related underlying diseases and previous treatments.
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Affiliation(s)
- Sandra Schönburg
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany
- *Correspondence: Sandra Schönburg
| | - Wilhelm Bauer
- Department of Urology, Hospital Barmherzige Schwestern, Vienna, Austria
| | - Nasreldin Mohammed
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany
| | - Clemens Brössner
- Department of Urology, Hospital Barmherzige Schwestern, Vienna, Austria
| | - Paolo Fornara
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany
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Angulo JC, Schönburg S, Giammò A, Abellán FJ, Arance I, Lora D. Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and Adjustable Continence Therapy (ProACT) for male stress incontinence. PLoS One 2019; 14:e0225762. [PMID: 31790490 PMCID: PMC6886794 DOI: 10.1371/journal.pone.0225762] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/12/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Urinary incontinence is one of the most serious complications of prostate cancer treatment. The objective of this study was to assess efficacy and safety of Adjustable Transobturator Male System (ATOMS) compared to Adjustable Continence Therapy (proACT) for male stress urinary incotinence according to literature findings. MATERIAL AND METHODS A systematic review and meta-analysis on adjustable devices ATOMS and ProACT is presented. Studies on female or neurogenic incontinence were excluded. Differences between ATOMS and proACT in primary objective: dryness status (no-pad or one safety pad/day) after initial device adjustment, and in secondary objectives: improvement, satisfaction, complications and device durability, were estimated using random-effect model. Statistical heterogeneity among studies included in the meta-analysis was assessed using tau2, Higgins´s I2 statistics and Cochran´s Q test. RESULTS Combined data of 41 observational studies with 3059 patients showed higher dryness (68 vs. 55%; p = .01) and improvement (91 vs. 80%; p = .007) rate for ATOMS than ProACT. Mean pad-count (-4 vs. -2.5 pads/day; p = .005) and pad-test decrease (-425.7 vs. -211.4 cc; p < .0001) were also significantly lower. Satisfaction was higher for ATOMS (87 vs. 56%; p = .002) and explant rate was higher for proACT (5 vs. 24%; p < .0001). Complication rate for ProACT was also higher, but not statistically significant (17 vs. 26%; p = .07). Mean follow-up was 25.7 months, lower for ATOMS than ProACT (20.8 vs. 30.6 months; p = .02). The rate of working devices favoured ATOMS at 1-year (92 vs. 76; p < .0001), 2-years (85 vs. 61%; p = .0008) and 3-years (81 vs. 58%; p = .0001). Significant heterogeneity was evidenced, due to variable incontinence severity baseline, difficulties for a common reporting of complications, different number of adjustments and time of follow-up and absence of randomized studies. CONCLUSIONS Despite the limitations that studies available are exclusively descriptive and the follow-up is limited, literature findings confirm ATOMS is more efficacious, with higher patient satisfaction and better durability than ProACT to treat male stress incontinence.
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Affiliation(s)
- Javier C. Angulo
- Departamento Clínico, Universidad Europea de Madrid, Madrid
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, Spain
| | - Sandra Schönburg
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany
| | - Alessandro Giammò
- Department of Neuro-Urology, CTO-Spinal Unit, Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Ignacio Arance
- Departamento Clínico, Universidad Europea de Madrid, Madrid
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, Spain
| | - David Lora
- Instituto de Investigación Sanitaria Hospital "12 de Octubre" (i+12), Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
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Sling Surgery for Male Urinary Incontinence Including Post Prostatectomy Incontinence: A Challenge to the Urologist. Int Neurourol J 2019; 23:185-194. [PMID: 31607097 PMCID: PMC6790820 DOI: 10.5213/inj.1938108.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/02/2019] [Indexed: 11/22/2022] Open
Abstract
The management of postprostatectomy urinary incontinence (PPI) is still challenging for urologists. In recent decades, various kinds of male sling system have been developed and introduced; however, they have not yet shown as good a result as that of artificial urinary sphincter (AUS). However, a male sling is still in an important position because patients have a high demand for sling implantation, and it can allow the avoidance of the use of mechanical devices like AUS. Recently, the male sling has been widely used in mild-to-moderate PPI patients; however, there are no studies that compare individual devices. Thus, it is hard to directly compare the success rate of operation, and it is impossible to judge which sling system is more excellent. It is expected that many sling options will be available in addition to AUS in the near future with the technological development of various male slings and the accumulation of long-term surgical outcomes. In that in patients with PPI, sling implantation is an option that must be explained rather than an option that need not be explained to them, this review would share the latest outcomes and complications.
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Silva LAD, Simonetti R, Silva EMKD. Adjustable sling for the treatment of post-prostatectomy urinary incontinence: systematic review and meta-analysis. EINSTEIN-SAO PAULO 2019; 17:eRW4508. [PMID: 31553360 PMCID: PMC6748345 DOI: 10.31744/einstein_journal/2019rw4508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/08/2019] [Indexed: 11/05/2022] Open
Abstract
Urinary incontinence after prostatectomy has a significant negative impact on the quality of life of the patient. The surgical treatment includes several models of male slings, such as adjustable slings. The objective of this study was to evaluate the effectiveness and safety of adjustable sling in the treatment of post-prostatectomy urinary incontinence. This is a systematic review of literature. The following electronic databases were searched until January 2018: PubMed®, Embase, CENTRAL and LILACS. The keywords used in the search strategies were: "prostatectomy" [Mesh], "urinary incontinence" [Mesh] and "suburethral slings" [Mesh]. Randomized clinical trials and observational studies, with or without Control Group, and follow-up of more than 12 months were included. Only one randomized study with high risk of bias was included and it concluded the effectiveness equivalence between adjustable and non-adjustable slings. All other studies were cases series with patients of varying levels of incontinence intensity and history of pelvic radiation therapy and previous surgeries. The meta-analysis for 0 pad in 24 hours demonstrated an effectiveness of 53%. For the 0 to 1 pad test in 24 hours, the meta-analysis resulted in an effectiveness of 69%. Risk factors for surgery failure include prior radiation, severity of post-prostatectomy urinary incontinence, and previous surgeries. The meta-analysis of the extrusion rate was 9.8% and the most commonly reported adverse effects were pain and local infection. Evidence of low quality indicates that adjustable slings are effective for treating post-prostatectomy urinary incontinence, with frequency of adverse events similar to the surgical option considered gold standard (the artificial urinary sphincter implant).
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Complications of the urinary incontinence system ATOMS: description of risk factors and how to prevent these pitfalls. World J Urol 2019; 38:1795-1803. [DOI: 10.1007/s00345-019-02962-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022] Open
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Giammò A, Ammirati E, Tullio A, Bodo G, Manassero A, Gontero P, Carone R. Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: results of a single centre. Int Braz J Urol 2019; 45:127-136. [PMID: 30521175 PMCID: PMC6442148 DOI: 10.1590/s1677-5538.ibju.2018.0171] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 08/25/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose: The aim of our study is to evaluate the efficacy and safety of ATOMS® system for the treatment of postoperative male stress urinary incontinence (SUI). Materials and methods: We retrospectively evaluated all patients treated at our institution for postoperative male SUI with ATOMS® implant. We excluded patients with low bladder compliance (< 20 mL / cmH2O), uncontrolled detrusor overactivity, detrusor underactivity (BCI < 100), urethral or bladder neck stricture and low cystometric capacity (< 200 mL). Results: From October 2014 to July 2017 we treated 52 patients, mean age 73.6 years. Most of them (92.3%) had undergone radical prostatectomy, 3.85% simple open prostatectomy, 3.85% TURP; 28.8% of patients had undergone urethral surgery, 11.5% adjuvant radiotherapy; 57.7% had already undergone surgical treatment for urinary incontinence. The average24 hours pad test was 411.6 g (180 – 1100). The mean follow-up was 20.1 months (8.1 – 41.5) 30.8% of patients were dry, 59.6% improved ≥ 50%, 7.7% improved < 50% and 1.9% unchanged. In total 73.1% reached social continence. There was a significant reduction of the 24 hours pad test and ICIQ - UI SF scores (p < 0.01). In the postoperative follow-up we detected complications in 8 patients (19%): 5 cases of displacement of the scrotal port, in 2 cases catheterization difficulties, one case of epididimitis and concomitant superficial wound infection; no prosthesis infection, nor explants. Radiotherapy, previous urethral surgery,previous incontinence surgery were not statistically related to social continence rates (p 0.65;p 0.11;p 0.11). Conclusions: The ATOMS® system is an effective and safe surgical treatment of mild and moderate male postoperative SUI with durable results in the short term.
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Affiliation(s)
- Alessandro Giammò
- Department of Neuro-Urology, CTO - Spinal Unit, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Enrico Ammirati
- Department of Urology, Molinette Hospital, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Annarita Tullio
- Hygiene and Clinical Epidemiology Unit, S. Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Gianni Bodo
- Department of Neuro-Urology, CTO - Spinal Unit, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alberto Manassero
- Department of Neuro-Urology, CTO - Spinal Unit, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paolo Gontero
- Department of Urology, Molinette Hospital, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberto Carone
- Department of Neuro-Urology, CTO - Spinal Unit, Città della Salute e della Scienza di Torino, Turin, Italy
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Sling Procedures for Post Prostatectomy Incontinence: What Devices Are Out There? and What Are Their Results? CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mühlstädt S, Hüsch T, Bauer RM. [Differentiated surgical treatment of male stress urinary incontinence-between intention and reality?]. Urologe A 2019; 58:640-650. [PMID: 31089755 DOI: 10.1007/s00120-019-0947-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The differentiated surgical treatment of male urinary incontinence is a very interesting and sometimes also emotional topic, in which evidence is increasingly maturing. Nowadays, the most common surgical procedures are fixed sling and adjustable incontinence systems as well as the artificial urinary sphincter. The evidence for the procedures varies and there is currently a lack of prospective, comparative studies. The challenging question is: Which operation is the best for which patient? The following article is intended to give an overview of the surgical options and a constructive attempt to differentiate the indication.
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Affiliation(s)
- S Mühlstädt
- Universitätsklinik für Urologie und Nierentransplantation Martin-Luther-Universität, Ernst-Grube-Straße 40, 06120, Halle / Saale, Deutschland.
| | - T Hüsch
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Deutschland
| | - R M Bauer
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität, Campus Großhadern, München, Deutschland
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Esquinas C, Angulo JC. Effectiveness of Adjustable Transobturator Male System (ATOMS) to Treat Male Stress Incontinence: A Systematic Review and Meta-Analysis. Adv Ther 2019; 36:426-441. [PMID: 30560525 PMCID: PMC6824356 DOI: 10.1007/s12325-018-0852-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Adjustable transobturator male system (ATOMS) is a surgical device developed to treat male stress urinary incontinence (SUI) after prostate surgery. The objective was to assess the effectiveness of the ATOMS device to treat male SUI as described in the literature. METHODS 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. We excluded studies on female incontinence. We employed the DerSimonian and Laird method for defining heterogeneity, calculating the grouped standard mean deviation (SMD). The primary objective of this review is the assessment of clinical efficacy based on the achievement of dryness after device adjustment, defined as use of no pad or one safety pad per day (PPD). The secondary objective was focused on analysing improvement of incontinence with the device. Magnitude of effect was calculated by analysing decrease in pad count (PPD) and/or in 24-h pad test. Number and severity of complications according to Clavien-Dindo classification were also reviewed. RESULTS The pooled data of 1393 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-h pad test decrease were - 4.14 PPD and - 443 cc, respectively. There is significant heterogeneity of the sample analysed, 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 explantations in 5.75%. No randomized study has been developed so far to compare ATOMS to other devices for treating male SUI. CONCLUSION 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 after prostate surgery. Better results are evidenced for patients with less than 6 PPD before implantation, non-irradiated patients and use of third-generation device with silicone-covered pre-attached scrotal port.
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Affiliation(s)
- Cristina Esquinas
- Departamento Clínico, Universidad Europea de Madrid, Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Javier C Angulo
- Departamento Clínico, Universidad Europea de Madrid, Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
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Urethral Bulking and Salvage Techniques for Post-Prostatectomy Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Angulo JC, Arance I, Ojea A, Carballo M, Rodríguez A, Pereira J, Rebassa M, Teyrouz A, Escribano G, Teba F, Madurga B, Martins FE, Cruz F. Patient satisfaction with adjustable transobturator male system in the Iberian multicenter study. World J Urol 2019; 37:2189-2197. [DOI: 10.1007/s00345-019-02639-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022] Open
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MacLachlan L, Mourtzinos A. Current Update on Management of Male Stress Urinary Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Angulo JC, Fonseca J, Esquinas C, Ojea A, Rodríguez A, Rabassa M, Teba F, Escribano G, Cruz F. Adjustable transobturator male system (ATOMS ®) as treatment of stress urinary incontinence secondary to transurethral resection of the prostate. Actas Urol Esp 2018; 42:567-573. [PMID: 29929737 DOI: 10.1016/j.acuro.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Feasibility study to evaluate efficacy and safety of Adjustable Transobturator Male System (ATOMS®) for male stress urinary incontinence (SUI) after transurethral resection of the prostate. MATERIALS AND METHODS Twenty patients were implanted ATOMS® for SUI caused by transurethral resection of the prostate with or without radiotherapy. Incontinence severity was evaluated as mild (2 pads/day), moderate (3-5 pads/day) or severe (≥6pads/day), and dryness as none or one security pad/day. Changes in pad-test and pad-count after adjustment were investigated, together with operative parameters, patient satisfaction with the procedure, and number and grade of complications (Clavien-Dindo). RESULTS Median age was 76.5years. Five patients received previous pelvic radiation (3 prostate, 2 rectal cancer) and 2 (10%) previous failed artificial urinary sphincter with urethral erosion and mechanical failure, respectively. Preoperative SUI was mild in 4 (20%), moderate in 7 (35%) and severe in 9 (45%). Median filling of the system was 13.5ml. Median pad-test decreased from 375±855ml baseline to 10±31.5ml and pad-count from 4±3 to 0±1.5 after adjustment (1±3fillings). Postoperative SUI distribution was mild in 2 (10%), moderate in one (5%) and severe in 2 (10%). Satisfaction rate was 80%, equal for transurethral resection of the prostate with/without previous radiotherapy. No patient had urinary retention after catheter removal. Complications presented in 3 (15%) patients, all minor. After median 38.5mo follow-up no system has been removed, 19 (95%) self-considered better than before and 11 (55%) very much better. CONCLUSION Based on short-term efficacy and patient satisfaction ATOMS® can be considered a realistic alternative for SUI after transurethral resection of the prostate, even after irradiation. Absence of urethral erosion and very limited problems make this alternative especially attractive for cases with diminished dexterity, advanced age and previous failed treatments.
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Affiliation(s)
- J C Angulo
- Hospital Universitario de Getafe, Universidad Europea de Madrid, Getafe, Madrid, España; Fundação Champalimaud, Lisboa, Portugal.
| | - J Fonseca
- Fundação Champalimaud, Lisboa, Portugal
| | - C Esquinas
- Hospital Universitario de Getafe, Universidad Europea de Madrid, Getafe, Madrid, España
| | - A Ojea
- Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - A Rodríguez
- Hospital Arquitecto Marcide, Ferrol, La Coruña, España
| | | | - F Teba
- Hospital Universitario de La Princesa, Madrid, España
| | | | - F Cruz
- Centro Hospitalar São João, Oporto, Portugal
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Mühlstädt S, Friedl A, Zachoval R, Mohammed N, Schumann A, Theil G, Fornara P. An overview of the ATOMS generations: port types, functionality and risk factors. World J Urol 2018; 37:1679-1686. [DOI: 10.1007/s00345-018-2548-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/25/2018] [Indexed: 11/29/2022] Open
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Esquinas C, Arance I, Pamplona J, Moraga A, Dorado JF, Angulo JC. Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS®) with preattached scrotal port. Actas Urol Esp 2018; 42:473-482. [PMID: 29642999 DOI: 10.1016/j.acuro.2018.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS®) with preattached scrotal port. MATERIAL AND METHOD An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. RESULTS We analysed 60 consecutive patients with a follow-up of 21±22 months. The baseline pad-test was 465±450mL, and the pad-count was 5+3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60±25min, the hospital stay was 1±0 days, and the visual analogue scale of pain on day 1 after surgery was 0±1. The total filling was 16.5±7mL, and the number of refillings was 1±2. The pad-test and pad-count after the adjustment were 0±20mL and 0±1, respectively (both p<.0001 compared with baseline). SUI disappeared (81.7%) or remained mild (11.7%), moderate (5%) or severe (1.6%). We observed a reduction in the ICIQ-SF (p<.0001) and IIQ-7 scores (p=.0003). Both continence (p=.002) and satisfaction (p=.03) were lower in the irradiated patients. Complications occurred in 11 cases (18.6%), 8 (13.5%) of which were grade I and 3 (5.1%) of which were grade 3. The treatment satisfaction rate was 91.7%, and the patient-perceived overall improvement at 1 year was highly pronounced (PGI-I score, 1±1; GRA, 6±1). CONCLUSIONS SUI treatment of men using third-generation ATOMS® is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively.
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Affiliation(s)
- C Esquinas
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España
| | - I Arance
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España
| | - J Pamplona
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España
| | - A Moraga
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España
| | | | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España.
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Manso M, Alexandre B, Antunes-Lopes T, Martins-da-Silva C, Cruz F. Is the adjustable transobturator system ATOMS® useful for the treatment of male urinary incontinence in low to medium volume urological centers? Actas Urol Esp 2018; 42:267-272. [PMID: 29174630 DOI: 10.1016/j.acuro.2017.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Urinary incontinence (UI) is a complication of radical prostatectomy (RP) and transurethral resection of the prostate (TURP). The gold-standard treatment is the artificial urinary sphincter, however, new treatments have been investigated. OBJECTIVE To examine the outcome of an adjustable transobturator male system (ATOMS®) in men with UI after prostatic surgery in a low to medium volume continence center. MATERIALS AND METHODS Twenty-five men with UI were implanted with ATOMS® system between 2012 and 2014. The most common indication was UI after RP (92%), followed by UI after TURP (8%). Eleven patients (44%) had received adjuvant external beam radiotherapy (RT). Patients were considered to be 'dry' if they stopped wearing pads or needed just one protective pad per day; and improved if the daily number of pads used decreased by at least half. The Incontinence Quality of Life questionnaire (ICIQ-SF) was used, adding a verbal question about the satisfaction of the patient considering the outcome. RESULTS After a mean follow-up of 21.56 months, 64% were dry and 8% revealed a significant improvement. The success of the procedure was negatively correlated with the severity of the previous UI and with previous treatment with RT. Concerning patients satisfaction, 84% of the patients would repeat the procedure. CONCLUSION ATOMS® offers good rates of cure and improvement of UI after prostatic surgery with a reasonable rate of minor complications. The results of this study, performed in a low to medium volume continence center, are comparable to the results achieved in high volume continence centers.
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Affiliation(s)
- M Manso
- Urology Department, Centro Hospitalar São João, Porto, Portugal.
| | - B Alexandre
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - T Antunes-Lopes
- Urology Department, Centro Hospitalar São João, Porto, Portugal; i3S Institute for Innovation and Health Research, Porto, Portugal
| | - C Martins-da-Silva
- Urology Department, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - F Cruz
- Urology Department, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Porto, Portugal; i3S Institute for Innovation and Health Research, Porto, Portugal
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Angulo JC, Cruz F, Esquinas C, Arance I, Manso M, Rodríguez A, Pereira J, Ojea A, Carballo M, Rabassa M, Teyrouz A, Escribano G, Rodríguez E, Teba F, Celada G, Madurga B, Álvarez-Ossorio JL, Marcelino JP, Martins FE. Treatment of male stress urinary incontinence with the adjustable transobturator male system: Outcomes of a multi-center Iberian study. Neurourol Urodyn 2018; 37:1458-1466. [PMID: 29315765 DOI: 10.1002/nau.23474] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/30/2017] [Indexed: 11/09/2022]
Abstract
AIM To evaluate effectiveness and safety of the adjustable transobturator male system (ATOMS) for male stress urinary incontinence (SUI). MATERIAL AND METHODS A retrospective multicenter study was conducted in nine Iberian institutions using a board-approved database for 215 patients intervened between 2012 and 2017, with no case excluded. Continence status, patient satisfaction, number, and grade of complications (Clavien-Dindo) and factors affecting dry rate at adjustment were evaluated. Multivariate analysis defined the population at best success rate. Incontinence recurrence due to device failure and/or explant was evaluated and Kaplan-Meier curve for durability performed. RESULTS Adjustment was achieved at a mean 1.4 ± 1.9 fillings. Dry-rate after adjustment was 80.5% (96.2% mild and 75.3% moderate-severe), 121 (56.3%) used no pads, and 52 (24.2%) a security pad with urine loss under 10 mL. Mean basal daily pad-test and pad-count decreased from 484 ± 372.3 mL and 3.9 ± 2 pads to 63.5 ± 201.2 mL and 0.9 ± 1.5pads (both P < 0.0001). Satisfaction rate was 85.1% (94.3% mild and 82.1% moderate-severe). Factors associated to dryness were: lesser severity of SUI (P < .0001), absence of radiotherapy (P = 0.0002) and device generation (P = 0.05). Multivariate analysis revealed absence of radiation (OR = 3.12; 1.36-7.19), mild (OR = 19.61; 3.95-100), and moderate (OR = 2.48; 1.1-5.59) SUI were independent predictors. Complications presented in 33(15.35%); 66.7% grade 1, 9.1% grade 2, and 24.2% grade 3. At 24.3 ± 15 mo mean follow-up device was explanted in seven (3.25%) and SUI worsened after adjustment in nine (4.2%). Dry-rate at follow-up was 73% and durability of device in dry patients at adjustment was 89.8% (82.9-94) at 2-years. CONCLUSIONS 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.
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Affiliation(s)
- Javier C Angulo
- Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain
| | | | - Cristina Esquinas
- Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain
| | - Ignacio Arance
- Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | - Fernando Teba
- Hospital Universitario de la Princesa, Madrid, Spain
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Friedl A, Schneeweiss J, Stangl K, Mühlstädt S, Zachoval R, Hruby S, Gründler T, Kivaranovic D, Fornara P, Lusuardi L, Brössner C. The Adjustable Transobturator Male System in Stress Urinary Incontinence After Transurethral Resection of the Prostate. Urology 2017; 109:184-189. [PMID: 28712889 DOI: 10.1016/j.urology.2017.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of the Adjustable Transobturator Male System (ATOMS) in men with stress urinary incontinence after transurethral resection of the prostate (TURP). MATERIALS AND METHODS From a large international prospectively administrated ATOMS register, we identified 49 patients with an ATOMS device as a result of persistent stress urinary incontinence after TURP. For evaluation, the men were divided into standard transurethral resection of the prostate (sTURP) and palliative transurethral resection of the prostate (pTURP) in radiated patients. Baseline and follow-up measurements included continence parameters, urodynamics, quality-of-life surveys (Patient Global Impression-Improvement and International Consultation on Incontinence Questionnaire-Short Form), and pain ratings. The dry rate (0-1 security pad/<10 mL urine loss), the success rate (overall improvement), removals, complications, and treatment failures were recorded. A P value of <.05 was considered statistically significant. RESULTS After a median of 34 and 22 months' follow-up and 2-3 adjustments, the sTURP and pTURP cohorts had 58% and 50% dry rates and 90% and 87% success rates. Hence, no improvement was seen in 10% and 13%. The removal rate was higher in pTURP (50% vs 10%, P = .0171) and infection was the most common side effect (50%) observed. Neither intraoperative nor Clavien-Dindo 4 and 5 adverse events were recorded. In sTURP and pTURP, the median daily pad count and the pad test improved significantly (all P <.001), and quality-of-life parameters shifted to a high satisfaction level (P <.001 and P = .001). Urodynamics remained unchanged and postoperative pain was not an issue. CONCLUSION The ATOMS device shows promising treatment outcomes in patients after TURP and a similar efficacy as in postprostatectomy incontinence. There is no difference in continence outcome between sTURP and pTURP; however, a higher removal rate was found after pTURP, which may be important for patient counseling.
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Affiliation(s)
- Alexander Friedl
- Department of Urology, Barmherzige Schwestern Krankenhaus, Vienna, Austria.
| | | | - Kathrin Stangl
- Department of Urology, Barmherzige Schwestern Krankenhaus, Vienna, Austria
| | - Sandra Mühlstädt
- Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin Luther University, Halle (Saale), Germany
| | - Roman Zachoval
- Thomayer Hospital, Department of Urology and 1st and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Stephan Hruby
- Department of Urology, Landeskrankenhaus Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Therese Gründler
- Department of Urology, Landeskrankenhaus Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Danijel Kivaranovic
- Department of Statistics and Operations Research, University of Vienna, Vienna, Austria
| | - Paolo Fornara
- Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin Luther University, Halle (Saale), Germany
| | - Lukas Lusuardi
- Department of Urology, Landeskrankenhaus Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Clemens Brössner
- Department of Urology, Barmherzige Schwestern Krankenhaus, Vienna, Austria
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Vismara Fugini A, Giovanessi L, Tosana M. Experience after 12 cases with the adjustable transobturator male sling for postprostatectomy stress urinary incontinence. Urologia 2017; 84:0. [PMID: 28708202 DOI: 10.5301/uj.5000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of the study was the prospective evaluation of the efficacy of the adjustable transobturator male system (ArgusT®) for the treatment of postprostatectomy stress urinary incontinence (PPI). METHODS Twelve consecutive patients were treated with ArgusT system for PPI. All patients were comprehensively evaluated preoperatively and after 3 and 6 months regarding daily pad use, residual urine, Incontinence Quality of Life Scale (I-QoL) score and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) score. Cure rate was defined as no pad use or one pad (used for security reasons). RESULTS At 3 and 6 months, we achieved a cure rate of 91%. The mean number of pads per day decreased from 4 ± 1.3 to 0.7 ± 0.9 and 0.5 ± 0.9 after 3 and 6 months, respectively (p<0.001). Only one patient showed no significant improvement. Compared with baseline, the mean ICIQ-SF score dropped from 17.3 ± 2.8 to 2.7 ± 3.8 and 2.4 ± 3.8, at 3 and 6 months, respectively (p<0.001). The mean I-QoL score also improved significantly from 53.1 ± 20.3 to 99.5 ± 11 and 96.8 ± 12.5 after 3 and 6 months, respectively (p<0.001). Postoperative acute urinary retention was seen in one patient. CONCLUSIONS In our early experience, the ArgusT system offers effective, safe and minimally invasive treatment option for PPI.
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Affiliation(s)
- Andrea Vismara Fugini
- Urology Unit, Surgical Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia - Italy
| | - Luca Giovanessi
- Urology Unit, Surgical Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia - Italy
| | - Michelangelo Tosana
- Urology Unit, Surgical Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia - Italy
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Hennessey DB, Hoag N, Gani J. Impact of bladder dysfunction in the management of post radical prostatectomy stress urinary incontinence-a review. Transl Androl Urol 2017; 6:S103-S111. [PMID: 28791229 PMCID: PMC5522793 DOI: 10.21037/tau.2017.04.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Bladder dysfunction is a relatively common urodynamic finding post radical prostatectomy (RP). It can be the sole cause of post prostatectomy incontinence (PPI) or may be found in association with stress urinary incontinence (SUI). The aim of this review is to provide a comprehensive review of the diagnosis and different treatments of post RP bladder dysfunction. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, PPI, detrusor overactivity (DO), detrusor underactivity (DU), impaired compliance, anticholinergic, onabotulinumtoxinA (Botox®) and sacral neuromodulation (SNM). Definitions, general overview and management options were extracted from the relevant medical literature. DO, DU and impaired compliance are common and may occur alone or in combination with SUI. In some patients the conditions exist pre RP, in others they arise due to denervation and surgical changes. DO can be treated with anticholinergics, Botox® and SNM. DO may need to be treated before SUI surgery. DU may be a contraindication to male sling surgery as some patients may go into urinary retention. Severely impaired bladder compliance may be a contraindication to SUI surgery as the upper tracts may be at risk. Each individual dysfunction may affect the outcome of PPI treatments and clinicians should be alert to managing bladder dysfunction in PPI patients.
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Affiliation(s)
- Derek B Hennessey
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Nathan Hoag
- Department of Urology, Victoria General Hospital, Victoria, British Columbia, Canada
| | - Johan Gani
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Urology, Western Health, Footscray, Victoria, Australia
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Sahai A, Abrams P, Dmochowski R, Anding R. The role of male slings in post prostatectomy incontinence: ICI-RS 2015. Neurourol Urodyn 2017; 36:927-934. [PMID: 28444702 DOI: 10.1002/nau.23264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/28/2017] [Indexed: 11/08/2022]
Abstract
AIMS Post prostatectomy stress urinary incontinence can significantly impact on quality of life and is bothersome for patients. The artificial urinary sphincter is still considered the gold standard surgical treatment. Male slings are an alternative surgical option and several designs are currently available. This review will focus on efficacy, adverse events, and mechanism of action of male slings. The context of this review was a proposal at the ICI-RS meeting 2015. Following synthesis of the evidence we address the question: does it matter how male slings work? METHODS The proposal lecture was reviewed and a comprehensive review of the literature undertaken utilising the PubMed database. RESULTS Male slings can be broadly divided into adjustable retropubic and suburethral transobturator slings. Male slings are efficacious and can improve quality of life. Adjustable retropubic slings appear to be compressive but studies suggest efficacy can be achieved without voiding dysfunction. Transobturator slings work by urethral compression and/or re-locating the urethral bulb. There is a recognized failure rate in all sling types and most studies suggest radiotherapy as a risk factor for failure. Adjustable slings have the ability to be altered to optimize continence or to prevent retention of urine. However, there appears to be a higher explantation rate in some of these systems. CONCLUSIONS It is important to understand how male slings work and by doing so we are more reliably able to choose the appropriate sling, predict outcomes, and as a result counsel patients. Suggestions for future research are proposed.
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Affiliation(s)
- Arun Sahai
- Department of Urology, Guy's Hospital, Kings College London, London, UK
| | - Paul Abrams
- Bristol Urological Institute, University of Bristol, Southmead Hospital, Bristol, UK
| | - Roger Dmochowski
- Department of Urologic Surgery, Medical Center North, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ralf Anding
- Department of Neuro-Urology, University Hospital, Bonn, Germany
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Barski D, Gerullis H, Otto T. Review of surgical implant procedures for male incontinence after radical prostatectomy according to IDEAL framework. Updates Surg 2017; 69:327-338. [DOI: 10.1007/s13304-017-0460-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/01/2017] [Indexed: 12/27/2022]
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Outcome Measures of Adjustable Transobturator Male System with Pre-attached Scrotal Port for Male Stress Urinary Incontinence After Radical Prostatectomy: A Prospective Study. Adv Ther 2017; 34:1173-1183. [PMID: 28405960 DOI: 10.1007/s12325-017-0528-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The objective of this study was to report outcome measures with third-generation pre-attached scrotal port adjustable transobturator male system (ATOMS) for male stress urinary incontinence (SUI) after radical prostatectomy. METHODS A prospective open study was conducted on consecutive patients. Evaluation included cough test, urethroscopy, filling and voiding cystometry, 24-h pad count and pad test, patient-reported outcomes (ICIQ-SF, IIQ-7, PGI, GRA, and VAS), complications according to the Clavien-Dindo system, operative results, number of adjustments, and filling of the system. RESULTS Thirty-four patients with median pad test 510 (170-1225) ml were operated on. Preoperative SUI was mild (5.9%), moderate (17.6%), and severe (76.5%). At median 18.5 (12-26) months follow-up distribution of SUI was none (85.3%), mild (8.8%), and moderate (5.9%). Median intraoperative filling was 14 (8-17) ml, number of adjustments 1 (0-5), and total filling 17.5 (11-33.5) ml. At 3 months, median ICIQ-SF (p = 0.0001) and IIQ-7 (p < 0.0001) decreased. At 12 months, 24-h pad count and pad test decreased (both p < 0.0001), residual volume slightly increased (p = 0.018), PGI-I was 1 (1-3), GRA 6 (3-6), and 97% were satisfied with treatment. Continence (p = 0.016) and satisfaction (p = 0.09) were worse in irradiated patients. Median operative time was 67 (35-120) min, hospital stay 1 (1-3) days, and VAS for pain on postoperative day 1 was 0 (0-2). Complications presented in 14.7% (8.8% grade I and 5.9% grade III). CONCLUSION Treatment of severe male SUI after radical prostatectomy with pre-attached scrotal port ATOMS is safe and very effective in the short term. A positive cough test before implant and intraoperative overfilling of the system may optimize patient selection and results.
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Mason J, Erickson B. The Male Transobturator Sling for Stress Incontinence After the Treatment of Prostate Cancer. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0425-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Buresova E, Vidlar A, Grepl M, Student V, Student V. Single-centre experience in using the adjustable transobturator male system in treatment of stress urinary incontinence in patients after radical prostatectomy. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817701054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context: Urinary incontinence is the most threatening complication after radical prostatectomy. This disorder has an important impact on the quality of life of patients and its treatment is a challenge for urologists as well. Objective: The objective of this article is to report our experience with the adjustable transobturator male system (ATOMS, AMI, Austria) for the treatment of post-prostatectomy incontinence. Material and methods: A total of 35 men with post-prostatectomy incontinence were treated. Before and after device implantation, the number of pads used per day was counted, and a one-hour pad test, uroflowmetry and postmicturition residual volume were assessed. Prior to surgery, anastomosis stricture was either ruled out or treated. To evaluate the success rate, ‘cured’ was defined as no pad use or one safety pad, ‘improved’ was defined as one or two pads or reduction of pad usage by more than 50%, respectively. All data about efficacy and safety were collected from all 35 patients. Results: After a median (range) follow-up of 21.2 (3–63) months, the success rate was 32 out of 35 patients (91.5%) with 22 patients (62.9%) ‘cured’ and 10 patients (28.6%) ‘improved’. Recovery of continence was achieved in seven patients (20.0%). The remaining patients (80%) needed an adjustment. The mean (range) number of adjustments to reach desired results (continence, improvement or patient satisfaction) was 4.3 (1–15). The most common adverse event was transient perineal pain, which was reported in 14 (40%) patients and disappeared within two weeks. Temporary urine retention appeared in one patient (2.9%). There were three cases (8.6%) of wound infection at the site of a port leading to explantation of the port in two patients (5.7%) and the removal of the system in one patient (2.9%). Conclusion: Treatment of post-prostatectomy incontinence with the self-anchoring ATOMS is safe and effective.
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Affiliation(s)
- Eva Buresova
- Clinic of Urology, University Hospital Olomouc, Czech Republic
| | - Ales Vidlar
- Clinic of Urology, University Hospital Olomouc, Czech Republic
| | - Michal Grepl
- Clinic of Urology, University Hospital Olomouc, Czech Republic
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Reitz A, Bauer S, Hüsch T, Haferkamp A. [Not Available]. PRAXIS 2017; 106:1115-1120. [PMID: 28976257 DOI: 10.1024/1661-8157/a002797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Dieser Übersichtsartikel beleuchtet den aktuellen Kenntnisstand zur Ätiologie, Diagnostik und Therapie der Harninkontinenz des Mannes. In der Ätiologie der Harninkontinenz beim Mann spielt die radikale Prostatektomie eine herausragende Rolle, aber auch das benigne Prostatasyndrom, neurologische Erkrankungen oder metabolische Störungen können zu einer Harninkontinenz beim Mann führen. In der Diagnostik ist neben der Basisdiagnostik eine qualifizierte urodynamische Beurteilung unabdingbar, um die zugrunde liegenden pathophysiologischen Mechanismen aufzudecken und Chancen und Risiken der verfügbaren Therapie- bzw. Operationstechniken abschätzen zu können. Die Primärtherapie der Harninkontinenz beim Mann ist konservativ und schliesst eine qualifizierte Beckenboden- und Sphinktertherapie einschliesslich Biofeedback ein. Die Auswahl der operativen Techniken unterliegt dem Ausmass der Inkontinenz, den individuellen Gegebenheiten des Patienten, der Patientenpräferenz, der Expertise des Operateurs und einzelnen Kontraindikationen für bestimmte Verfahren. Auch ein längeres Intervall nach radikaler Prostatektomie oder ein Tumorprogress sind keine Ausschlusskriterien für eine operative Therapie. Der oft hohe Leidensdruck und das breite Spektrum von in geübten Händen wenig invasiven Operationstechniken rechtfertigen eine breite Indikationsstellung für eine prothetische Versorgung.
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Affiliation(s)
| | | | - Tanja Hüsch
- 3 Urologische Klinik und Poliklinik, Universitätsklinikum der Johannes Gutenberg Universität, Mainz, Deutschland
| | - Axel Haferkamp
- 3 Urologische Klinik und Poliklinik, Universitätsklinikum der Johannes Gutenberg Universität, Mainz, Deutschland
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[Not Available]. PRAXIS 2017; 106:1143. [PMID: 29041847 DOI: 10.1024/1661-8157/a002829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Friedl A, Mühlstädt S, Zachoval R, Giammò A, Kivaranovic D, Rom M, Fornara P, Brössner C. Long-term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study. BJU Int 2016; 119:785-792. [PMID: 27868328 DOI: 10.1111/bju.13684] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the long-term effectiveness and safety of the adjustable transobturator male system (ATOMS® , Agency for Medical Innovations A.M.I., Feldkirch, Austria) in a European-wide multicentre setting. PATIENTS AND METHODS In all, 287 men with stress urinary incontinence (SUI) were treated with the ATOMS device between June 2009 and March 2016. Continence parameters (daily pad test/pad use), urodynamics (maximum urinary flow rate, voiding volume, residual urine), and pain/quality of life (QoL) ratings (visual analogue scale/Leeds Assessment of Neuropathic Symptoms and Signs, International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]/Patient Global Impression of Improvement [PGI-I]) were compared preoperatively and after intermediate (12 months) as well as after individual maximum follow-up. Overall success rate, dry rate (<10 mL/day and 0-1 pad/day), device durability, treatment failure, and device complications were recorded. Nonparametric tests were used for statistical analyses. RESULTS After a median (interquartile range [IQR]) follow-up of 31 (10-54) months and a median (IQR) of 3 (2-4) adjustments, the overall success rate was 90% (258 men) and the dry rate was 64% (184). Daily pad test and pad use decreased from a median of 400 mL/day and 4 pads/day to a median of 18 mL/day and 1 pad/day (both P < 0.001), concomitantly QoL ratings significantly improved and changed to a high level of satisfaction (PGI-I 4 to 2, ICIQ-SF 17 to 5; both P < 0.001). The UI results at 12 months were comparable to those at final follow-up. Chronic pain and intraoperative complications did not occur. Most of the postoperative complications were Clavien-Dindo grade I-III (no grade IV or V). At present, 231 (80%) of all the ATOMS devices are still functioning; 56 (20%) were removed, the most common reason being local titanium intolerance (41%) and leak/dysfunction (30%). The operating time and continence outcome varied between port generations. In this regard the latest port generation (silicone-covered scrotal port) was superior to its predecessors. Primary implantation (P = 0.002), good physical health (P = 0.001), and no history of radiotherapy (P < 0.001) were prognostic factors for beneficial treatment outcome. CONCLUSION The ATOMS device is safe and shows high treatment efficacy and patient satisfaction in the largest cohort study to date. The latest generation, with its pre-attached silicone-covered scrotal port, is superior to its predecessors. Significantly better results were achieved with primary implantation and in those without a history of radiotherapy.
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Affiliation(s)
- Alexander Friedl
- Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria
| | - Sandra Mühlstädt
- Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin-Luther-University, Halle-Wittenberg, Halle/Saale, Germany
| | - Roman Zachoval
- Thomayer Hospital, Department of Urology and 1st and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | | | - Danijel Kivaranovic
- Center for Medical Statistics, Informatics, and Intelligent Systems, Vienna, Austria
| | - Maximilian Rom
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Paolo Fornara
- Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin-Luther-University, Halle-Wittenberg, Halle/Saale, Germany
| | - Clemens Brössner
- Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria
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Salomon L, Droupy S, Yiou R, Soulié M. [Functional results and treatment of functional dysfunctions after radical prostatectomy]. Prog Urol 2016; 25:1028-66. [PMID: 26519966 DOI: 10.1016/j.purol.2015.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/30/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the functional results and treatment of functional dysfunctions after radical prostatectomy for localized prostate cancer. MATERIAL AND METHOD Bibliography search was performed from the database Medline (National Library of Medicine, Pubmed) selected according to the scientific relevance. The research was focused on continence, potency, les dyserections, couple sexuality, incontinence, treatments of postoperative incontinence, dysrection and trifecta. RESULTS Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Despite recent developments in surgical techniques, post-radical prostatectomy urinary incontinence (pRP-UI) continues to be one of the most devastating complications, which affects 9-16% of patients. Sphincter injury and bladder dysfunction are the most common causes or pRP-UI. The assessment of severity of pRP-UI that affects the choice of treatment is still not well standardized but should include at least a pad test and self-administered questionnaires. The implantation of an artificial urinary sphincter AMS800 remains the gold standard treatment for patients with moderate to severe pRP-UI. The development of less invasive techniques such as the male sling of Pro-ACT balloons has provided alternative therapeutic options for moderate and slight forms of pRP-UI. Most groups now consider the bulbo-urethral compressive sling as the treatment of choice for patients with non-severe pRP-UI. The most appropriate second-line therapeutic strategy is not clearly determined. Recent therapies such as adjustable artificial urinary sphincters and sling and stem cells injections have been investigated. Maintenance of a satisfying sex life is a major concern of a majority of men facing prostate cancer and its treatments. It is essential to assess the couple's sexuality before treating prostate cancer in order to deliver comprehensive information and consider early therapeutic solutions adapted to the couple's expectations. Active pharmacological erectile rehabilitation (intracavernous injections or phosphodiesterase type 5 inhibitors [PDE5i] on demand, during in the month following surgery) or passive (daily PDE5i after surgery) might improve the quality of erections especially in response to PDE5i. Unimpaired aspects of sexual response (orgasm) may, when the erection is not yet recovered, represent an alternative allowing the couple to preserve intimacy and complicity. Androgen blockade is a major barrier to maintain or return to a satisfying sex. Trifecta is a simple tool to present in one way the results of radical prostatectomy: in case of bilateral neurovascular preservation, Trifecta is 60% whatever the surgical approach. CONCLUSION Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Various treatments of postoperative incontinence and dysrections exist. Functional disorders after surgery have to be treated to ameliorate quality of life of patients.
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Affiliation(s)
- L Salomon
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
| | - S Droupy
- Service d'urologie et d'andrologie, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France
| | - R Yiou
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - M Soulié
- Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France
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Mühlstädt S, Friedl A, Mohammed N, Schumann A, Weigand K, Kawan F, Göllert C, Kahlert C, Theil G, Fischer K, Fornara P. Five-year experience with the adjustable transobturator male system for the treatment of male stress urinary incontinence: a single-center evaluation. World J Urol 2016; 35:145-151. [PMID: 27156092 DOI: 10.1007/s00345-016-1839-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/26/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We report on our 5-year experience with the adjustable transobturator male system (ATOMS®, A.M.I., Feldkirch, Austria). METHODS Between 10-2009 and 10-2014, 54 patients received an ATOMS. The mean follow-up of this retrospective observational trial was 27.5 ± 18.4 (2.3-59) months. Within each follow-up, the following were evaluated: micturition protocol, 24-h pad count, uroflowmetry and residual volume. Statistical analysis was performed with SigmaPlot® 11.0, p < 0.05 considered as significant. RESULTS Stress urinary incontinence (SUI) I°, II° and III° was seen in 1 (1.9 %), 16 (29.6 %) and 37 patients (68.5 %), respectively. In summary, 48.1 % of the patients became "dry" (0-"safty pad"/day), while 29.6 % achieved at least an "improvement" of about more than 50 % (1-2 pads/day), which corresponds to an overall success rate of 77.7 %. The mean number of pads/day decreased from 7.7 to 1.6. Regarding the initial degree of SUI, patients with mild or moderate incontinence had a significantly better outcome (p = 0.002, 95 % CI 0.9066 to 2.760). Postoperative complications were scaled according to the Clavien classification, in which we have seen 4 grade I-, 1 grade IIIa- and 9 grade IIIb-complications (overall 25.9 %). The evaluation of quality of life by ICIQ-SF showed a significant improvement (p = 0.0001, 95 % CI -14.56 to -11.75). CONCLUSION The treatment of male SUI using the ATOMS incontinence system achieved the best results in patients with mild and moderate incontinence. For severe incontinent patients, the system represents an efficient alternative.
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Affiliation(s)
- Sandra Mühlstädt
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
| | - Alexander Friedl
- Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria
| | - Nasreldin Mohammed
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - André Schumann
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Karl Weigand
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Felix Kawan
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Christian Göllert
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Christin Kahlert
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Gerit Theil
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Kersten Fischer
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Paolo Fornara
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
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Friedl A, Mühlstädt S, Rom M, Kivaranovic D, Mohammed N, Fornara P, Brössner C. Risk Factors for Treatment Failure With the Adjustable Transobturator Male System Incontinence Device: Who Will Succeed, Who Will Fail? Results of a Multicenter Study. Urology 2016; 90:189-94. [DOI: 10.1016/j.urology.2015.12.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/23/2015] [Accepted: 12/25/2015] [Indexed: 10/22/2022]
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Bauer RM, Oelke M, Hübner W, Grabbert M, Kirschner-Hermanns R, Anding R. [Urinary incontinence in men]. Urologe A 2016; 54:887-99; quiz 900. [PMID: 26081822 DOI: 10.1007/s00120-015-3826-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Stress urinary incontinence in men is predominantly iatrogenic whereby radical prostatectomy is the most common cause with persistent stress urinary incontinence rates varying between 10 % and 25 %. The first line therapy for postoperative male stress urinary incontinence is physiotherapy, especially pelvic floor muscle rehabilitation. If conservative treatment fails to show sufficient improvement, surgical therapy is recommended. Several treatment options are currently available for the surgical treatment of male stress urinary incontinence including artificial sphincters, adjustable and functional sling systems, bulking agents and implantable balloon systems.
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Affiliation(s)
- R M Bauer
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München, Deutschland,
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Kretschmer A, Hübner W, Sandhu JS, Bauer RM. Evaluation and Management of Postprostatectomy Incontinence: A Systematic Review of Current Literature. Eur Urol Focus 2016; 2:245-259. [PMID: 28723370 DOI: 10.1016/j.euf.2016.01.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/22/2015] [Accepted: 01/03/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Radical prostatectomy is the most common reason for male stress urinary incontinence. There is still uncertainty about its diagnostic and therapeutic management. OBJECTIVE To evaluate current evidence regarding the diagnosis and therapy of postprostatectomy incontinence (PPI). EVIDENCE ACQUISITION A systematic review of the literature was performed in October 2015 using the Medline database. EVIDENCE SYNTHESIS Diagnosis and conservative treatment of PPI are currently mostly based on expert opinions. Pelvic floor muscle training is the noninvasive treatment of choice of PPI. For invasive management of moderate to severe PPI, the artificial urinary sphincter is still the treatment of choice, but an increasing number of adjustable and nonadjustable, noncompressive as well as compressive devices are used more frequently. However, no randomized controlled trial has yet investigated the outcome of one specific surgical treatment or compared the outcome of different surgical treatment options. CONCLUSIONS The level of evidence addressing the surgical management of PPI is still unsatisfactory. Further research is urgently needed. PATIENT SUMMARY Incontinence after the removal of the prostate (postprostatectomy incontinence) is the most common cause of male stress urinary incontinence. First-line therapy is physiotherapy and lifestyle changes. If no satisfactory improvement is obtained, various surgical treatment options are available. The most commonly used is the artificial urinary sphincter, but other treatment options like male slings are also available.
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Affiliation(s)
- Alexander Kretschmer
- Ludwig-Maximilians-Universität, Urologische Klinik und Poliklinik, Campus Großhadern, Munich, Germany.
| | - Wilhelm Hübner
- Landesklinikum Weinviertel Korneuburg, Klinik für Urologie, Kornneuburg, Austria
| | - Jaspreet S Sandhu
- Department of Surgery/Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ricarda M Bauer
- Ludwig-Maximilians-Universität, Urologische Klinik und Poliklinik, Campus Großhadern, Munich, Germany
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Van Bruwaene S, De Ridder D, Van der Aa F. The use of sling vs sphincter in post-prostatectomy urinary incontinence. BJU Int 2015; 116:330-42. [PMID: 25382641 DOI: 10.1111/bju.12976] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The artificial urinary sphincter (AUS) is considered the 'gold standard' in post-prostatectomy urinary incontinence. However, in recent years, male slings have gained much popularity due to the ease of surgery, good functional results and low complications rates. This review systematically shows the evidence for the different sling systems, describes the working mechanism, and compares their efficacy against that of the AUS. Furthermore subgroups of patients are defined who are not suited to undergo sling surgery.
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Affiliation(s)
| | - Dirk De Ridder
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Bauer RM, Rutkowski M, Kretschmer A, Casuscelli J, Stief CG, Huebner W. Efficacy and complications of the adjustable sling system ArgusT for male incontinence: results of a prospective 2-center study. Urology 2015; 85:316-20. [PMID: 25623675 DOI: 10.1016/j.urology.2014.10.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 10/09/2014] [Accepted: 10/14/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate prospectively the efficacy and the safety of the ArgusT in male patients with persistent stress urinary incontinence. METHODS A prospective 2-center evaluation was conducted on consecutive patients treated for persistent stress incontinence. Forty-two patients were implanted with the ArgusT male sling system with no associated surgery. Measurements included daily pad usage, 24-hour pad weight test, International Quality of Life questionnaire, International Consultation on Incontinence Questionnaire short form, and the Patient Global Impression of Improvement. Postoperative complications were assessed using the Clavien-Dindo classification. The definitions used were cured, 0-5 g in 24-hour pad weight test; improved, reduction of urine loss in 24-hour pad weight test >50%; and failed, all others. RESULTS After a mean follow-up of 28.8 months (20-38 months), 26 patients were dry (61.9%) with a pad test of 0-5 g/24 hours. Eleven patients (26.2%) improved. Five patients are considered failures. Overall daily pad use, urine loss in the 24-hour pad test, and quality of life scores improved significantly after sling implantation. Median adjustment rate was 1.7. There were no perioperative complications. Postoperative complications were mainly grade I and II complications according to the Clavien-Dindo classification. CONCLUSION The ArgusT sling system offers an effective and safe treatment option for male patients with moderate to severe stress urinary incontinence in a follow-up >2 years, even after radiotherapy.
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Affiliation(s)
- Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
| | | | | | | | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Wilhelm Huebner
- Department of Urology, Clinic of Korneuburg, Korneuburg, Austria
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