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Téllez C, Diego R, Szczesniewski J, Giammò A, González-Enguita C, Schönburg S, Queissert F, Romero A, Gonsior A, Martins FE, Cruz F, Rourke K, Angulo JC. Results of Adjustable Trans-Obturator Male System for Stress Urinary Incontinence after Transurethral Resection or Holmium Laser Enucleation of the Prostate: International Multicenter Study. J Clin Med 2024; 13:4628. [PMID: 39200769 PMCID: PMC11354669 DOI: 10.3390/jcm13164628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Male stress urinary incontinence (SUI) after surgical treatment of benign prostatic enlargement (BPE) is an infrequent but dreadful complication and constitutes a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS®) in these patients is rather unknown, mainly due to the rarity of this condition. We aimed to assess the results of ATOMS to treat SUI after transurethral resection (TURP) or holmium laser enucleation (HoLEP) of the prostate. Methods: Retrospective multicenter study evaluating patients with SUI after TURP or HoLEP for BPE primarily treated with silicone-covered scrotal port (SSP) ATOMS implants in ten different institutions in Europe and Canada between 2018 and 2022. Inclusion criteria were pure SUI for >1 year after endoscopic treatment for BPE and informed consent to receive an ATOMS. The primary endpoint of the study was a dry rate (pad test ≤ 20 mL/day after adjustment). The secondary endpoints were: the total continence rate (no pads and no leakage), complication rate (Clavien-Dindo classification) and self-perceived satisfaction (Patient Global Impression of Improvement (PGI-I) scale 1 to 3). Descriptive analytics, Wilcoxon's rank sum test and Fisher's exact test were performed. Results: A total of 40 consecutive patients fulfilled the inclusion criteria, 23 following TURP and 17 HoLEP. After ATOMS adjustment, 32 (80%) patients were dry (78.3% TURP and 82.4% HoLEP; p = 1) and total continence was achieved in 18 (45%) patients (43.5% TURP and 47% HoLEP; p = 0.82). The median pad test was at a 500 (IQR 300) mL baseline (648 (IQR 650) TURP and 500 (IQR 340) HoLEP; p = 0.62) and 20 (IQR 89) mL (40 (IQR 90) RTUP and 10 (IQR 89) HoLEP; p = 0.56) after adjustment. Satisfaction (PGI-I ≤ 3) was reported in 37 (92.5%) patients (95.6% TURP and 88.2% HoLEP; p = 0.5). There were no significant differences between patients treated with TURP or HoLEP regarding the patient age, radiotherapy and number of adjustments needed. After 32.5 (IQR 30.5) months, median follow-up postoperative complications occurred in seven (17.5%) cases (two grade I and five grade II; three after TURP and four HoLEP) and two devices were removed (5%, both HoLEP). Conclusions: ATOMS is an efficacious and safe alternative to treat SUI due to sphincteric damage produced by endoscopic surgery for BPE, both TURP and HoLEP. Future studies with a larger number of patients may identify predictive factors that would allow better patient selection for ATOMS in this scenario.
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Affiliation(s)
- Carlos Téllez
- Clinical Department, Faculty of Biomedical Science, Universidad Europea, Carretera de Toledo, Km 12,500, Getafe, 28905 Madrid, Spain; (C.T.); (R.D.)
- Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12,500, Getafe, 28905 Madrid, Spain;
| | - Rodrigo Diego
- Clinical Department, Faculty of Biomedical Science, Universidad Europea, Carretera de Toledo, Km 12,500, Getafe, 28905 Madrid, Spain; (C.T.); (R.D.)
| | - Juliusz Szczesniewski
- Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12,500, Getafe, 28905 Madrid, Spain;
| | - Alessandro Giammò
- Department of Neuro-Urology, CTO/Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Via Zuretti 24, 10126 Torino, Italy;
| | - Carmen González-Enguita
- Department of Urology, Hospital Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain;
| | - Sandra Schönburg
- Department of Neuo-Urology, BG Klinikum Bergmannstrost Halle, Merseburger Str. 165, 06112 Halle (Saale), Germany
- Department of Urology and Kidney Transplantation, Martin Luther University, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Fabian Queissert
- Department of Urology and Pediatric Urology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
| | - Antonio Romero
- Department of Urology, Hospital Universitario Morales Meseguer, Avd. Marqués de los Vélez s/n, 30008 Murcia, Spain;
| | - Andreas Gonsior
- Klinik und Poliklinik für Urologie, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany;
| | - Francisco E. Martins
- Department of Urology, Centro Hospitalar Universitário de Lisboa Norte, Hospital Santa María, Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal;
| | - Francisco Cruz
- Department of Urology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;
- I3S Institute, Faculty of Medicine of Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal
| | - Keith Rourke
- Department of Urology, Alberta University, Hospital Edmonton, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada;
| | - Javier C. Angulo
- Clinical Department, Faculty of Biomedical Science, Universidad Europea, Carretera de Toledo, Km 12,500, Getafe, 28905 Madrid, Spain; (C.T.); (R.D.)
- Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12,500, Getafe, 28905 Madrid, Spain;
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Grabbert M, Bauer RM. [Urinary stress incontinence in men: diagnostic workup and modern surgical treatment]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:666-672. [PMID: 38814349 DOI: 10.1007/s00120-024-02355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/31/2024]
Abstract
Radical prostatectomy is the most common cause of urinary stress incontinence in male patients. The exact pathophysiology is not clearly defined but probably due multifactorial. Thorough preoperative diagnostic workup before surgical therapy appears to be crucial for good postoperative results. Various systems are available. The artificial urinary sphincter continues to be considered standard procedure with a high success rate, even in patients with more complex situations and severe urinary incontinence. However, there are also relevant complication and revision rates. Modern alternatives include various sling systems. The adjustable sling systems consist of a cushion that is placed against the urethral bulb and leads to a permanent increase in urethral resistance, which can be readjusted in different ways depending on the system implanted. The adjustable sling systems also seem to be an alternative in patients with a prior history of radiation therapy. The AdVance XP sling (Boston Scientific, Marlborough, MA, USA) is a fixed sling that corrects the postoperative hypermobility of the posterior urethra after radical prostatectomy and, thus, leads to a longer functional urethral length. Good long-term results after AdVance XP implantation are only possible in selected patients.
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Affiliation(s)
- Markus Grabbert
- Klinik für Urologie, Department Chirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Deutschland.
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Kovacevic N, Padmanabhan P. Surgical management of post prostatectomy incontinence. Prostate Int 2024; 12:65-69. [PMID: 39036757 PMCID: PMC11255890 DOI: 10.1016/j.prnil.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Post prostatectomy incontinence (PPI) is a well-recognized and bothersome complication following radical prostatectomy. Conservative measures such as pelvic floor physical therapy, biofeedback, and medication are first line management of PPI. When first line therapies fail, patients are offered a variety of surgical procedures based on the degree of incontinence, prior radiation therapy, and comorbidities. Among the various surgical options, placement of an artificial urinary sphincter (AUS) is the gold standard for PPI. However, AUS placement has a high rate of re-operation and requires good manual dexterity. In cases of mild-moderate incontinence, especially in patients without prior radiation therapy, male slings and proACT are a less invasive option. Bulking therapy, although highly successful for female stress urinary incontinence (SUI), is not currently advised in the treatment of male SUI. Regardless of surgical approach used to treat PPI, providers should counsel patients regarding risks of re-operation and have an open an honest discussion regarding the degree of continence that can be restored following each procedure.
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Angulo JC, Giammò A, Queissert F, Schönburg S, González‐Enguita C, Gonsior A, Romero A, Martins FE, Antunes‐Lopes T, González R, Szczesniewski J, Téllez C, Cruz F, Rourke KF. The effectiveness of adjustable trans-obturator male system (ATOMS) in radiated patients is reduced: A propensity score-matched analysis. BJUI COMPASS 2024; 5:506-514. [PMID: 38633825 PMCID: PMC11019248 DOI: 10.1002/bco2.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/24/2023] [Accepted: 12/21/2023] [Indexed: 04/19/2024] Open
Abstract
Objectives This study aimed to compare the effectiveness and safety of the adjustable trans-obturator male system (ATOMS®) to treat post-prostatectomy incontinence (PPI) in radiated patients compared with non-radiated patients, using propensity score-matching analysis to enhance the validity of the comparison. Patients and methods Consecutive men with PPI treated with silicone-covered scrotal port ATOMS (A.M.I., Feldkirch, Austria) in nine different institutions between 2016 and 2022 were included. Preoperative assessment evaluated 24-h pad usage, urethroscopy and urodynamics, if indicated. Propensity score-matching analysis was based on age, length of follow-up, previous PPI treatment, previous bladder neck stricture, androgen deprivation and pad usage. The primary endpoint was dry rate, defined as no pads post-operatively with a security pad allowed. The secondary endpoints were complications, device removal and self-perceived satisfaction with the Patient Global Impression of Improvement (PGI-I) scale. Results Of the 710 included patients, 342 were matched, and the study groups were balanced for the baseline matched variables. The mean baseline 24-h pad was 4.8 in both groups (p = 0.48). The mean follow-up was 27.5 ± 18.6 months, which was also equivalent between groups (p = 0.36). The primary outcome was achieved in 73 (42.7%) radiated patients and in 115 (67.3%) non-radiated patients (p < 0.0001). The mean pad count at the last follow-up was 1.5 and 0.8, respectively (p < 0.0001). There was no significant difference in complications (p = 0.94), but surgical revision and device explant rates were higher (p = 0.03 and p = 0.01, respectively), and the proportion of patients highly satisfied (PGI-I = 1) was lower in the radiated group (p = 0.01). At sensitivity analysis, the study was found to be reasonably robust to hidden bias. Conclusion ATOMS implantation significantly outperformed in patients without adjuvant radiation over radiated patients.
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Affiliation(s)
- Javier C. Angulo
- Clinical Department, Faculty of Biomedical ScienceUniversidad EuropeaMadridSpain
- Department of UrologyHospital Universitario de GetafeMadridSpain
| | - Alessandro Giammò
- Department of Neuro‐Urology, CTO/Spinal Cord UnitAOU Città della Salute e della Scienza di TorinoTurinItaly
| | - Fabian Queissert
- Department of Urology and Pediatric UrologyUniversity Hospital MuensterMünsterGermany
| | - Sandra Schönburg
- Department of Urology and Kidney TransplantationMartin Luther UniversityHalle (Saale)Germany
| | | | - Andreas Gonsior
- Klinik und Poliklinik für UrologieUniversity of LeipzigLeipzigGermany
| | - Antonio Romero
- Department of UrologyHospital Universitario Morales MeseguerMurciaSpain
| | - Francisco E. Martins
- Department of UrologyCentro Hospitalar Universitário de Lisboa Norte, Hospital Santa MaríaLisbonPortugal
| | - Tiago Antunes‐Lopes
- Department of UrologyCentro Hospitalar São JoãoPortoPortugal
- Faculty of Medicine of PortoI3S InstitutePortoPortugal
| | - Raquel González
- Department of UrologyHospital Fundación Jiménez DíazMadridSpain
| | | | - Carlos Téllez
- Clinical Department, Faculty of Biomedical ScienceUniversidad EuropeaMadridSpain
- Department of UrologyHospital Universitario de GetafeMadridSpain
| | - Francisco Cruz
- Department of UrologyCentro Hospitalar São JoãoPortoPortugal
- Faculty of Medicine of PortoI3S InstitutePortoPortugal
| | - Keith F. Rourke
- Department of UrologyAlberta University, Hospital EdmontonEdmontonAlbertaCanada
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Juliebø-Jones P, Roth I, Tzelves L, Hjelle KM, Moen CA, Esperto F, Somani BK, Beisland C. Current status of the adjustable transobturator male system (ATOMS TM) for male stress urinary incontinence. Front Surg 2024; 11:1377788. [PMID: 38567359 PMCID: PMC10985136 DOI: 10.3389/fsurg.2024.1377788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Male stress urinary incontinence is a debilitating condition, which can occur after prostate surgery. In persistent cases, surgery is indicated and a number of options are available. This includes one of the male slings, Adjustable transobturator male system (ATOMSTM, A.M.I, Austria). There are now an increasing number of studies published. This review provides an overview of the current status of this implant device including technical considerations, surgical outcomes and potential advantages and disadvantages compared to alternatives such as the artificial urinary sphincter.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingunn Roth
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | - Karin M. Hjelle
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Arvei Moen
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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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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Angulo JC, Téllez C, Giammò A, González-Enguita C, Schoenburg S, Queissert F, Szczesniewski J, González R, Romero A, Gonsior A, Martins FE, Antunes-Lopes T, Cruz F, Rourke K. Results of Adjustable Trans-Obturator Male System in Patients with Prostate Cancer Treated with Prostatectomy and Radiotherapy: A Multicenter Study. J Clin Med 2023; 12:4721. [PMID: 37510835 PMCID: PMC10380664 DOI: 10.3390/jcm12144721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Treatment of male stress incontinence in patients with prostate cancer treated with radical prostatectomy and adjuvant pelvic radiation is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is not well established, despite the general belief that outcomes are worse than in patients without radiation. (2) Methods: Retrospective multicenter study evaluating patients treated with silicone-covered scrotal port (SSP) ATOMS implant after radical prostatectomy and radiotherapy in nine different institutions between 2016 and 2022. The primary endpoint was dry patient rate, defined as pad-test ≤ 20 mL/day. The secondary endpoints were complication rate (defined using Clavien-Dindo classification), device removal and self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank-sum test, Fisher's exact test and logistic regression were performed using stepwise method with a 0.15 entry and 0.1 stay criteria. (3) Results: 223 patients fulfilled the criteria for inclusion and 12 (5.4%) received salvage prostatectomy after radiation and 27 (12.1%) previous devices for stress incontinence. After ATOMS adjustment, 95 patients (42.6%) were dry and 36 (16.1%) had complications of any grade (grade I, n = 20; grade II, n = 11; grade III, n = 5) during the first 3 months postoperatively. At a mean of 36 ± 21 months follow-up, the device was explanted in 26 (11.7%) patients. Regarding self-perceived satisfaction with the implant, 105 of 125 patients (84%) considered themselves satisfied (PGI-I 1 to 3). In the univariate analysis, dryness was associated to younger age (p = 0.06), primary prostatectomy (p = 0.08), no previous incontinence surgery (p = 0.02), absence of overactive bladder symptoms (p = 0.04), absence of bladder neck stricture (p = 0.001), no need of surgical revision (p = 0.008) and lower baseline incontinence severity (p = 0.0003). Multivariate analysis identified absence of surgical revision (p = 0.018), absence of bladder neck stricture (p = 0.05), primary prostatectomy (p = 0.07) and lower baseline incontinence severity (p < 0.0001) were independent predictors of dryness. A logistic regression model was proposed and internally validated. (4) Conclusions: ATOMS is an efficacious and safe alternative to treat male incontinence after radical prostatectomy and adjuvant radiotherapy. Factors predictive of dryness are identified in this complex scenario to allow for better patient selection.
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Affiliation(s)
- Javier C Angulo
- Clinical Department, Faculty of Biomedical Science, Universidad Europea, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
- Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
| | - Carlos Téllez
- Clinical Department, Faculty of Biomedical Science, Universidad Europea, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
- Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
| | - Alessandro Giammò
- Department of Neuro-Urology, CTO/Spinal Cord Unit, AOU Città Della Salute e Della Scienza di Torino, Via Zuretti 24, 10126 Torino, Italy
| | - Carmen González-Enguita
- Department of Urology, Hospital Fundación Jiménez Díaz, Av. de Los Reyes Católicos, 2, 28040 Madrid, Spain
| | - Sandra Schoenburg
- Department of Urology and Kidney Transplantation, Martin Luther University, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Fabian Queissert
- Department of Urology and Pediatric Urology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Juliusz Szczesniewski
- Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
| | - Raquel González
- Department of Urology, Hospital Fundación Jiménez Díaz, Av. de Los Reyes Católicos, 2, 28040 Madrid, Spain
| | - Antonio Romero
- Department of Urology, Hospital Universitario Morales Meseguer, Avd. Marqués de Los Vélez s/n., 30008 Murcia, Spain
| | - Andreas Gonsior
- Klinik und Poliklinik für Urologie, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Francisco E Martins
- Department of Urology, Centro Hospitalar Universitário de Lisboa Norte, Hospital Santa María, Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal
| | - Tiago Antunes-Lopes
- Department of Urology, Centro Hospitalar São João and Faculty of Medicine of University Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- I3S Institute, R. Alfredo Allen 208, 4200-135 Porto, Portugal
| | - Francisco Cruz
- Department of Urology, Centro Hospitalar São João and Faculty of Medicine of University Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- I3S Institute, R. Alfredo Allen 208, 4200-135 Porto, Portugal
| | - Keith Rourke
- Department of Urology, Alberta University, Hospital Edmonton, 8440 112 St. NW, Edmonton, AB T6G 2B7, Canada
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Queissert F, Bruecher B, Schrader AJ. A New Proximal Adjustable Sling ATOMS SSP ® Implantation Technique with Focus on the Urethral Bulb: Lessons Learned from Revision Surgery. J Clin Med 2023; 12:4409. [PMID: 37445443 DOI: 10.3390/jcm12134409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/18/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Adjustable sling ATOMS-SSP results in ventral compression of the urethra with favorable results in the treatment of men with mild to moderate stress incontinence. However, with transobturator tunneling and mesh fixation, the surgeon has a range of options, which leads to different results and sometimes unfavorable positioning of the silicone cushion. Using retrograde urethrography (RUG), we identified ATOMS patients with considerable misplacement. We then modified the implantation technique when we performed the revision, and now present here our first experiences with this new surgical technique. METHODS Patients after ATOMS-SSP implantation at our clinic were systematically subjected to a RUG if incontinence persisted after adjustments. In case of unfavorable positioning, a revision was performed with the aim of achieving an idealized urethroproximal position of the silicone pad. During follow-up, a repeat RUG was performed, and both subjective and objective outcome parameters were recorded. RESULTS Four men met the above criteria and underwent revision with reimplantation using our new technique. All patients postoperatively experienced significantly improved continence. RUGs demonstrated an ideal ATOMS position immediately below the proximal bulbar urethra. CONCLUSIONS Our proximal implantation technique, presented here for the first time, allows optimal positioning of the ATOMS SSP, which is reflected in the objective parameters and RUG. Its use in primary implantation should also be considered and an expansion to the indication of severe stress incontinence seems possible, but this should only be done in studies.
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Affiliation(s)
- Fabian Queissert
- Clinic for Urology and Pediatric Urology, University Hospital Muenster, 48149 Münster, Germany
| | - Benedict Bruecher
- Clinic for Urology and Pediatric Urology, University Hospital Muenster, 48149 Münster, Germany
| | - Andres J Schrader
- Clinic for Urology and Pediatric Urology, University Hospital Muenster, 48149 Münster, Germany
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Téllez C, Szczesniewski J, Virseda-Chamorro M, Arance I, Angulo JC. Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery. Curr Oncol 2023; 30:4153-4165. [PMID: 37185429 PMCID: PMC10136884 DOI: 10.3390/curroncol30040316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: The adjustable trans-obturator male system (ATOMS) is a surgical device developed to treat post-prostatectomy incontinence (PPI) after prostate cancer treatment. We review the current literature on this anti-incontinence device with the intention of assessing the effectiveness, safety and duration of the silicone-covered scrotal port (SSP) ATOMS, the only generation of the device that is currently available. (2) Material and Methods: Non-systematic literature review is performed. Forty-eight full-text articles are assessed for eligibility. Case reports, expert opinions or commentaries without specific data reported (n = 6), studies with patients who underwent intervention before 2014 (IP or SP ATOMS; n = 10), and studies with incontinence after transurethral resection of the prostate (TUR-P; n = 2) are excluded for analysis. Thirty studies with SSP ATOMS are included in a qualitative synthesis that incorporates systematic reviews (n = 3), articles partially overlapping with other previously published studies (e.g., follow-up or series updates; n = 9), and studies focusing on specific populations (n = 8). Only articles revealing outcomes of SSP ATOMS were included in the quantitative synthesis of results (n = 10). (3) Results: the pooled data of 1515 patients from the 10 studies with SSP ATOMS confirmed very satisfactory results with this device after adjustment: dry rate: 63-82%, improved rate: 85-100%, complication rate: 7-33%, device infection rate: 2.7-6.2% and explant rate: 0-19%. The durability of the device is reassuring, with 89% of devices in place 5 years after implantation. (4) Conclusion: Despite the absence of randomized controlled studies, the literature findings confirm results of SSP ATOMS appear equivalent to those of artificial urinary sphincters (AUSs) in terms of continence, satisfaction and complications, but with a lower rate of revision in the long-term. A prospective study identified that patients with daily pad test results <900 mL and a Male Stress Incontinence Grading Scale (MSIGS) of not 4 (i.e., early and persistent stream or urine loss) are the best candidates. Future studies centered on the elder population at higher risk of impaired cognitive ability and in patients including radiation as prostate cancer treatment are needed.
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Affiliation(s)
- Carlos Téllez
- Clinical Department, Faculty of Biomedical Sciences, Universidad Europea, 28805 Madrid, Spain
- Urology Department, Hospital Universitario de Getafe, 28805 Madrid, Spain
| | - Juliusz Szczesniewski
- Clinical Department, Faculty of Biomedical Sciences, Universidad Europea, 28805 Madrid, Spain
- Urology Department, Hospital Universitario de Getafe, 28805 Madrid, Spain
| | - Miguel Virseda-Chamorro
- Urology Department, Hospital Nacional de Parapléjicos, Carretera de la Peraleda, S/N, 45004 Toledo, Spain
| | - Ignacio Arance
- Clinical Department, Faculty of Biomedical Sciences, Universidad Europea, 28805 Madrid, Spain
- Urology Department, Hospital Universitario de Getafe, 28805 Madrid, Spain
| | - Javier C Angulo
- Clinical Department, Faculty of Biomedical Sciences, Universidad Europea, 28805 Madrid, Spain
- Urology Department, Hospital Universitario de Getafe, 28805 Madrid, Spain
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Long-Term Survival Rate of ATOMS Implant for Male Stress Urinary Incontinence and Management of Late Complications. J Clin Med 2023; 12:jcm12062296. [PMID: 36983297 PMCID: PMC10056794 DOI: 10.3390/jcm12062296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023] Open
Abstract
Background: stress urinary incontinence (SUI) still represents a major drawback of prostate surgery. The aim of this study is to evaluate long term efficacy, safety and survival of ATOMS system implant in a single center. Methods: we retrospectively included al consecutive patients treated with ATOMS implant for SUI from October 2014 to July 2019. Patients received anamnesis, urodynamic evaluation, pre- and postoperative 24 h pad test and count. Patients were considered “continent” when dry or when wearing a security pad (social continence). Results: we treated99 patientswith median age 77.98 years (IQR 72.7–82.52). Most of the patients had undergone radical prostatectomy. Median follow-up was 62.9 months (IQR 47.5–75.9). At last follow-up 74 (74.7%) patients reported continence.We had 21 early (<30 days) postoperative complications, all Clavien-Dindo (CD) grade 1: [11 temporary perineal pain, 4 urinary retention, 3 scrotal edema, 2 superficial wound dehiscence, 1 dysuria]. We had late postoperative complications in 28 patients 7 port dislocations requiring surgical repositioning (CD 3a), 6 device removals (CD 3a) due to port erosion (2), inefficacy (2), cushion leakage (1), mesh detachment (1), perineal pain (5), 2 cases of port extrusion solved with port removal leaving the device in place (CD 3a), 2 superficial wound dehiscence (CD 1), 2 UTI (CD 1), 1 scrotal edema (CD 1), 1 cushion deflate (CD 1), 1 dysuria (CD 1), 1 perineal pain (CD 1). The survival of the device was 97% at 12 months, 93% at 24 months, 91% at 36 months, 90% at 48 months and 87.9% at 60 months. Conclusions: This study demonstrates the good safety and efficacy of ATOMS implant for the treatment of SUI.
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12
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Manini C, López-Fernández E, López JI, Angulo JC. Advances in Urological Cancer in 2022, from Basic Approaches to Clinical Management. Cancers (Basel) 2023; 15:1422. [PMID: 36900214 PMCID: PMC10000370 DOI: 10.3390/cancers15051422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/26/2023] Open
Abstract
This Special Issue includes 12 articles and 3 reviews dealing with several basic and clinical aspects of prostate, renal, and urinary tract cancer published during 2022 in Cancers, and intends to serve as a multidisciplinary chance to share the last advances in urological neoplasms [...].
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Affiliation(s)
- Claudia Manini
- Department of Pathology, San Giovanni Bosco Hospital, 10154 Turin, Italy
- Department of Sciences of Public Health and Pediatrics, University of Turin, 10124 Turin, Italy
| | - Estíbaliz López-Fernández
- FISABIO Foundation, 46020 Valencia, Spain
- Faculty of Health Sciences, European University of Valencia, 46023 Valencia, Spain
| | - José I. López
- Biocruces-Bizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - Javier C. Angulo
- Clinical Department, Faculty of Medical Sciences, European University of Madrid, 28005 Madrid, Spain
- Department of Urology, University Hospital of Getafe, 28907 Madrid, Spain
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13
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Quintana Franco L, González López R, Garde García H, Díez Rodríguez J, González Enguita C. Estado actual y evolución del manejo de la patología funcional y del suelo pélvico en los hospitales de la Comunidad de Madrid. Actas Urol Esp 2023. [DOI: 10.1016/j.acuro.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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14
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Quintana Franco LM, González López R, Garde García H, Díez Rodríguez JM, González Enguita C. Evolution and current status of the management of functional and pelvic floor pathology in the hospitals of the Community of Madrid. Actas Urol Esp 2023; 47:187-192. [PMID: 36731821 DOI: 10.1016/j.acuroe.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION AND OBJECTIVE Pelvic floor dysfunction (PFD) includes a large number of pathologies subjected to a significantly varied management, depending on the hospitals' resources and educational levels of their professionals. The aim of this study is to determine and describe the clinical variability in the management of PFD in the urology departments of the public health centers of the Community of Madrid, as well as the resources currently available in these centers. MATERIAL AND METHODS The survey was carried out in September 2021 and was addressed to physicians specialized in functional urology in the public hospitals of the Community of Madrid. This survey is based on the one performed in 2011 by Díez et al. for the same purpose. The characteristics of the healthcare services provided in the different centers and the management of the main functional pathologies of the pelvic floor were analyzed. The results were compared with those of the 2011 survey for equivalent questions. RESULTS The number of Pelvic Floor Units (PFUs) has remarkably increased in the last 10 years. The use of adjustable devices in the treatment of male SUI has become widespread in the centers included in the survey. Laparoscopic/robotic sacrocolpopexy has become the gold standard treatment for pelvic organ prolapse (POP). CONCLUSIONS Multidisciplinary PFUs represent the reference framework for the management of PFD. Variability in the management of urinary incontinence, POP, bladder pain syndrome and pudendal nerve neuropathy is recognized.
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Affiliation(s)
| | | | - H Garde García
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Castellan P, Ferretti S, Litterio G, Marchioni M, Schips L. Management of Urinary Incontinence Following Radical Prostatectomy: Challenges and Solutions. Ther Clin Risk Manag 2023; 19:43-56. [PMID: 36686217 PMCID: PMC9851058 DOI: 10.2147/tcrm.s283305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Urinary incontinence is a common and debilitating problem in patients undergoing radical prostatectomy. Current methods developed to treat urinary incontinence include conservative treatments, such as lifestyle education, pelvic muscle floor training, pharmacotherapy, and surgical treatments, such as bulking agents use, artificial urinary sphincter implants, retrourethral transobturator slings, and adjustable male sling system. Pelvic floor muscle exercise is the most common management to improve the strength of striated muscles of the pelvic floor to try to recover the sphincter weakness. Antimuscarinic drugs, phosphodiesterase inhibitors, duloxetine, and a-adrenergic drugs have been proposed as medical treatments for urinary incontinence after radical prostatectomy. Development of new surgical techniques, new surgical tools and materials, such as male slings, has provided an improvement of outcomes after UI surgery. Such improvement is still ongoing, and the uptake of new devices might lead to even better outcomes after UI surgery.
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Affiliation(s)
| | - Simone Ferretti
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy,Correspondence: Simone Ferretti, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy, Tel +393278733805, Fax +390871357756, Email
| | - Giulio Litterio
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Michele Marchioni
- Department of Urology, ASL02 Abruzzo, Chieti, Italy,Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Luigi Schips
- Department of Urology, ASL02 Abruzzo, Chieti, Italy,Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
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ATOMS (Adjustable Trans-Obturator Male System) in Patients with Post-Prostatectomy Incontinence and Previously Treated Urethral Stricture or Bladder Neck Contracture. J Clin Med 2022; 11:jcm11164882. [PMID: 36013121 PMCID: PMC9410097 DOI: 10.3390/jcm11164882] [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: 07/02/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: Male stress incontinence in patients with previously treated urethral or bladder neck stricture is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is unknown. (2) Methods: All patients with primary ATOMS implants in our institution between 2014 and 2021 were included. The outcomes of patients with previously treated urethral or bladder neck stricture (≥6 months before ATOMS implant) and stable 16Ch urethral caliber were compared to those without a history of stricture. The primary endpoint was the dry patient rate, defined as the pad test ≤ 20 mL/day, and complication rate, including device removal. The secondary variable was self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank sum test, Fisher’s exact test and logistic regression were performed. (3) Results: One hundred and forty-nine consecutive patients were included, twenty-one (14%) previously treated for urethral or bladder neck stricture (seven urethroplasty, nine internal urethrotomy and five bladder neck incision). After ATOMS adjustment, 38% of the patients with treated stricture were continent compared to 83% of those without (p < 0.0001). After weighted matched observations using propensity score pairing, the proportion of continent patients without a previous stricture was 56% (p = 0.236). Complications occurred in 29% of the patients with stricture and in 20% of those without (p = 0.34). The severity of the complications was distributed evenly among the groups (p = 0.42). Regarding self-perceived satisfaction with the implant, 90% of the patients with stricture perceived the results satisfactorily (PGI-I 1−3) compared to 97% of the rest (p = 0.167). Stricture was associated with radiotherapy (p < 0.0001) and time from prostatectomy to implantation (p = 0.012). There was a moderate correlation between previous stricture and the severity of incontinence, both evaluated according to the 24-h pad test (Rho = 0.378; p < 0.0001) and the ICIQ-SF questionnaire (Rho = 0.351; p < 0.0001). Multivariate analysis for the factors predictive of failure after ATOMS adjustment revealed previous stricture (OR 4.66; 95% CI 1.2−18.87), baseline 24-h pad test (per 100 mL, OR 1.28; 95% CI 1.09−1.52) and final cushion volume (per mL, OR 1.34; 95% CI 1.19−1.55). This model predicted dryness with an AUC of 92%. After the PSMATCH procedure using a propensity score, the model remained unchanged, with the previous stricture (OR 8.05; 95% CI 1.08−110.83), baseline 24-h pad test (per 100 mL, OR 1.53; 95% CI 1.15−2.26) and final cushion volume (per mL, OR 1.45; 95% CI 1.17−2) being independent predictors and an AUC of 93%. (4) Conclusions: ATOMS can be used to treat male stress incontinence in patients with a history of stricture, although the effectiveness of the device is reduced. On the other hand, the security and perceived satisfaction were equivalent for both groups.
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Mokhtari N, Bazinet A, Pinar U, Ruggiero M, Robain G, Chartier-Kastler E. Neurogenic stress urinary incontinence management. From past to recent techniques: What have we learnt? Prog Urol 2022; 32:809-812. [PMID: 35840454 DOI: 10.1016/j.purol.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/10/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Urinary prostheses for the treatment of male stress urinary incontinence ranged from simple to adjustable bulbourethral compressing devices to complex artificial urinary sphincter. Those devices have remarkably evolved since the 1950s. In this article, we review the story of a patient who experienced this device evolution. His history provides us with the opportunity to retrieve the historical transformation of the incontinence prostheses around time. Moreover, this patient story challenges us on those devices past and present limitations.
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Affiliation(s)
- N Mokhtari
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France
| | - A Bazinet
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France; Department of Urology, University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Canada.
| | - U Pinar
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France
| | - M Ruggiero
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France
| | - G Robain
- Médecine physique et réadaptation, Sorbonne université, hôpital Rotschild, Paris, France
| | - E Chartier-Kastler
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France
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Gacci M, Sakalis VI, Karavitakis M, Cornu JN, Gratzke C, Herrmann TRW, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Schouten N, Smith EJ, Speakman MJ, Tikkinen KAO, Gravas S. European Association of Urology Guidelines on Male Urinary Incontinence. Eur Urol 2022; 82:387-398. [PMID: 35697561 DOI: 10.1016/j.eururo.2022.05.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
CONTEXT Urinary incontinence (UI) is a common condition in elderly men causing a severe worsening of quality of life, and a significant cost for both patients and health systems. OBJECTIVE To report a practical, evidence-based, guideline on definitions, pathophysiology, diagnostic workup, and treatment options for men with different forms of UI. EVIDENCE ACQUISITION A comprehensive literature search, limited to studies representing high levels of evidence and published in the English language, was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a grade of recommendation were assigned. EVIDENCE SYNTHESIS UI can be classified into stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence. A detailed description of the pathophysiology and diagnostic workup has been reported. Simple clinical interventions, behavioural and physical modifications, and pharmacological treatments comprise the initial management for all kinds of UI. Surgery for SUI includes bulking agents, male sling, and compression devices. Surgery for UUI includes bladder wall injection of botulinum toxin A, sacral nerve stimulation, and cystoplasty/urinary diversion. CONCLUSIONS This 2022 European Association of Urology guideline summary provides updated information on definition, pathophysiology, diagnosis, and treatment of male UI. PATIENT SUMMARY Male urinary incontinence comprises a broad subject area, much of which has been covered for the first time in the literature in a single manuscript. The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Guideline Panel has released this new guidance, with the aim to provide updated information for urologists to be able to follow diagnostic and therapeutic indications for optimising patient care.
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Affiliation(s)
- Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
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Refined Nomogram Incorporating Standing Cough Test Improves Prediction of Adjustable Trans-Obturator Male System (ATOMS) Success to Treat Post-Prostatectomy Male Stress Incontinence. J Pers Med 2022; 12:jpm12010094. [PMID: 35055409 PMCID: PMC8780728 DOI: 10.3390/jpm12010094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 02/07/2023] Open
Abstract
(1) Background: The adjustable transobturator male system (ATOMS) device serves to treat post-prostatectomy incontinence, as it enhances residual urinary sphincteric function by dorsal compression of the bulbar urethra. We investigated the clinical parameters affecting continence recovery using this device and developed a decision aid to predict success. (2) Methods: We reviewed consecutive men treated with first-time ATOMS for post-prostatectomy incontinence from 2014 to 2021 at our institution. Patient demographics, reported pads per day (PPD), 24-h pad-test and Standing Cough Test (SCT), results’ grades 1–4, according to Male Stress Incontinence Grading Scale (MSIGS), and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire were assessed. Treatment success was defined as no pads or a single PPD with ≤20-mL 24-h pad-test. Logistic regression was performed using a stepwise model (entry 0.15 and stay criterium 0.1) to evaluate independent variables’ determinant of dryness. Receiver-operating characteristic (ROC) curves for predictive variables were evaluated and their area under curve (AUC) was compared. A nomogram was generated and internally validated to predict probability of treatment success. (3) Results: Overall, 149 men (median age 70 years, IQR 7) were evaluated with a median follow-up of 45 months (IQR 26). Twelve patients (8%) had previous devices for incontinence, and 21 (14.1%) had pelvic radiation. Thirty-five men (23.5%) did not achieve continence after ATOMS adjustment (use of no or one security PPD with ≤20-mL 24-h pad-test). In univariate analysis, Charlson comorbidity index (p = 0.0412), previous urethroplasty (p = 0.0187), baseline PPD (p < 0.0001), 24-h pad-test (p < 0.0001), MSIGS (p < 0.0001), and ICIQ-SF questionnaire score (p < 0.0001) predicted ATOMS failure. In a multivariable model, 24-h pad-test (p = 0.0031), MSIGS (p = 0.0244), and radiotherapy (p = 0.0216) were independent variables, with AUC 0.8221. The association of MSIGS and 24-h pad-test was the superior combination (AUC 0.8236). A nomogram to predict the probability of ATOMS failure using the independent variables identified was proposed. (4) Conclusions: Several variables were identified as predictive of success for ATOMS using clinical history, physical examination (MSIGS), and factors that evaluate urine loss severity (PPD, 24-h pad-test, and ICIQ-SF questionnaire). MSIGS adds prognostic value to 24-h pad-test in assessing success of ATOMS device to treat post-prostatectomy incontinence. A nomogram was proposed to calculate the risk of ATOMS failure, which could be of interest to personalize the decision to use this device or not in the individual patient.
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20
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Ruiz S, Virseda-Chamorro M, Salinas J, Queissert F, Arance I, Angulo JC. Influence of ATOMS implant on the voiding phase of patients with post-prostatectomy urinary incontinence. Neurourol Urodyn 2021; 41:609-615. [PMID: 34969148 DOI: 10.1002/nau.24856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/12/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess changes in voiding phase, especially urethral resistance after post-prostatectomy urinary incontinence (PPI) treatment with the Adjustable TransObturator Male System (ATOMS). MATERIAL AND METHODS A longitudinal prospective study was performed on 45 men treated with ATOMS for PPI, with the intention to evaluate the changes produced by the implant on the voiding phase. Patients with preoperative urodynamic study were offered postoperative urodynamic evaluation, and both studies were compared. The following urodynamic date were evaluated: maximum voiding detrusor pressure, detrusor pressure at maximum flow rate, maximum flow rate (Qmax), voiding volume, post-void residue, bladder outlet obstruction index (BOOI), urethral resistance factor (URA), and bladder contractility index (BCI). The statistical analysis used were the mean comparison test for dependent groups (Student's t test) for parametric variables and the Wilcoxon test for non-parametric variables. The signification level was set at 95% bilateral. RESULTS A total of 37 patients (82.2%) used zero pads/day at the time of urodynamic postoperative evaluation and pad-test evolved from 592 ± 289 ml baseline to 25 ± 40 ml (p = 0.0001). Significant differences were observed in Qmax (15 ± 8.3 before and 11 ± 8.3 after surgery; p = 0.008), voiding volume (282 ± 130.7 before and 184 ± 99.92 after surgery). BOOI (-12 ± 23.9 before and -2 ± 21.4 after surgery; p = 0.025) and BCI (93 ± 46.4 before and 76 ± 46.0 after surgery; p = 0.044). In no case did we observe postoperative bladder outlet obstruction, according to URA parameter below 29 cm H2 O in all cases. There was not a significant variation either in post-void urinary residual volume (15 ± 47.4 before and 14 ± 24.2 after surgery, p = 0.867). CONCLUSIONS The ATOMS implant induces a decrease of Qmax, voided volume, and bladder contractility and an increase of BOOI. However, our findings suggest that ATOMS device does not cause bladder outlet obstruction.
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Affiliation(s)
- Sonia Ruiz
- Departamento Clinico, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, Spain.,Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - Jesús Salinas
- Servicio de Urología, Hospital Clínico San Carlos, Madrid, Spain
| | - Fabian Queissert
- Department of Urology and Pediatric Urology, University Hospital Muenster, Muenster, Germany
| | - Ignacio Arance
- Departamento Clinico, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, Spain.,Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Javier C Angulo
- Departamento Clinico, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, Spain.,Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
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ATOMS (Adjustable Transobturator Male System) Is an Effective and Safe Second-Line Treatment Option for Recurrent Urinary Incontinence after Implantation of an AdVance/AdVance XP Fixed Male Sling? A Multicenter Cohort Analysis. J Clin Med 2021; 11:jcm11010081. [PMID: 35011821 PMCID: PMC8745557 DOI: 10.3390/jcm11010081] [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] [Received: 11/22/2021] [Revised: 12/08/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: This study examined outcomes of second-line ATOMS implantation after failure of the fixed male sling (FMS) AdVance/AdVance XP. (2) Methods: A retrospective multicenter cohort analysis was carried out in men implanted with an ATOMS between 2011 and 2020 after failure of an AdVance/AdVance XP. Success was assessed on the basis of objective (dryness, 0-1 pad/24 h or >20 g/24 h pad test) and subjective results (PGI-I). We performed the Wilcoxon rank sum test, Fisher's exact test, logistic regression, and multivariate analysis. (3) Results: The study included 88 patients from 9 centers with a mean age of 71.3 years. No Clavien-Dindo > II complications occurred within the first 3 months after ATOMS implantation. A total of 10 cases (9%) required revision in the ensuing clinical course. After a mean follow-up of 42.5 months, 76.1% achieved social continence, and 56.8% used no pads at all. Mean urine leakage/24 h dropped from 422 g (3.9 pads) to 38 g (0.69 pads) and the mean ICIQ-SF decreased from 16.25 to 5.3 (p < 0.0001). PROMs (patient-reported outcome measures) showed improvement in 98.9% of cases, and 63.6% gave a "very much better" PGI-I rating. Multivariate analysis identified a lower probability of achieving maximum satisfaction for the following factors: the AdVance XP as first-line therapy (OR 0.35), a lower ICIQ-SF question 1 (OR 0.26), status post-irradiation (OR 0.14), and more severe pain prior to ATOMS implantation (OR 0.51). (4) Conclusions: Implantation of an ATOMS is an effective and safe second-line treatment option for recurrent urinary incontinence after implantation of an AdVance/AdVance XP sling. High patient satisfaction was demonstrated in a long-term follow-up.
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Adjustable Transobturator Male System (ATOMS) Infection: Causative Organisms and Clinical Profile. Urology 2021; 157:120-127. [PMID: 34425151 DOI: 10.1016/j.urology.2021.05.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the clinical profile and the organisms producing adjustable transobturator male system (ATOMS) infection in a contemporary series. METHODS Multicenter retrospective study evaluating patients undergoing ATOMS explant for clinical signs of infection from a series of 902 patients treated in 9 academic institutions. Clinical and microbiological data were evaluated. RESULTS Infection presented in 24 patients (2.7%). The median age was 73 ± 7yrs and the median interval from ATOMS implantation to explant 11 ± 26.5mo. Infection was diagnosed within 3-months after surgery in 7(29.2%). Scrotal port erosion was present in 6 cases (25%) and systemic symptoms of parenchymatous testicular infection in 2(8.3%). The culture of the periprosthetic fluid was positive in 20(83.3%): 12(50%) Gram-negative bacteria, 9(37.5%) Gram-positive cocci and 1(4.2%) yeast. The most frequent isolates were Enterococcus and Proteus sp. (16.7% each), followed by Pseudomona sp. and S. epidermidis (12.5% each). Methicillin resistant S. aureus was detected only in 1 case (4.2%). Despite the infection 17 patients (70.8%) were satisfied with the implant and 18(75%) received a second device (11 repeated ATOMS and 7 AUS) at a median 9.7 ± 12.6mo after explant. Limitations include retrospective design and lack of microbiological cultures in ATOMS explanted for non-infective cause. CONCLUSION Infection of a prosthetic device is a disturbing complication. A proportion of patients with ATOMS infection is associated to scrotal port erosion and/or parenchymatous urinary tract infection. Enterococcus and Proteus sp. are the most common organisms producing ATOMS infection and this could have implications for the selection of the most appropriate surgical prophylaxis.
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Abdunnur R, Kaufmann A. [Künstliche Harnsphincter zur Behandlung von Stress-Harninkontinenz - eine oft nicht ausgelastete Behandlungsoption in Deutschland]. Urologe A 2021; 60:696-705. [PMID: 34097109 DOI: 10.1007/s00120-021-01544-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
ABSTRAKT Harninkontinenz ist in Deutschland weit verbreitet und betrifft Millionen von Frauen und Männern. Vor allem Männer, die postoperativ dauerhaft inkontinent sind, werden hierzulande trotz der ausreichenden Verfügbarkeit chirurgischer Optionen unterbehandelt. Der künstliche Schließmuskel wird seit Jahrzehnten erfolgreich zur Behandlung angeborener und erworbener Stress-Harninkontinenz bei Männern und Frauen sowie neurogener Harninkontinenz eingesetzt und wird in Form neuer Modelle weiterentwickelt. Aufgrund der guten Ergebnisse, Es gilt jetzt als Standardtherapie für Männer mit anhaltender, mittelschwerer bis schwerer Harninkontinenz. Die operationstechnische Technik ist anspruchsvoll, kann aber erlernt werden. Die meisten Komplikationen können in erfahrenen Händen deutlich reduziert werden. Patientenzufriedenheit mit künstlichen Harnsphinctern (AUS) ist hoch und korreliert mit der Kontinenzrate und nicht mit der relativ hohen Revisionsrate, weshalb diese Behandlungsoption in Deutschland zunehmend mehr Patienten mit mittelschwerer bis schwerer Harninkontinenz angeboten werden sollte. Urologen in der allgemeinen Praxis spielen in diesem Zusammenhang eine zentrale Rolle.
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Affiliation(s)
- R Abdunnur
- Klinik für Urologie und Kinderurologie, Helios-Klinikum Schwelm, Dr. Moeller-Str. 15, 58332, Schwelm, Deutschland.
| | - A Kaufmann
- Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH, Viersener Straße 450, 41063, Mönchengladbach, Deutschland.
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[Alloplastic material in the treatment of urinary incontinence]. Urologe A 2021; 60:706-713. [PMID: 33942152 DOI: 10.1007/s00120-021-01530-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
Surgery for urinary incontinence is indicated after failure of conservative treatment with pelvic floor therapy. Different sling systems are the established treatment option for urinary incontinence for female and male patients. Tension-free vaginal tapes represent the standard of care in the surgical treatment of female stress urinary incontinence. In male patients with mild or moderate stress urinary incontinence, fixed repositioning slings or adjustable compressive slings represent minimally invasive alternatives to the artificial urinary sphincter. The use of surgical mesh material has been widely discussed within the last years. The current US Food and Drug Administration warning was focused on the use of transvaginal mesh implants in female patients with pelvic organ prolapse. Within the current debate, surgery for stress urinary incontinence and surgery for pelvic organ prolapse have often not been differentiated. With this ongoing discussion about the use of foreign material in reconstructive surgery, laparoscopic colposuspension might be performed more often in the near future.
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Rahnama'i MS, Marcelissen T, Geavlete B, Tutolo M, Hüsch T. Current Management of Post-radical Prostatectomy Urinary Incontinence. Front Surg 2021; 8:647656. [PMID: 33898508 PMCID: PMC8063855 DOI: 10.3389/fsurg.2021.647656] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
Prostate cancer is the second most common cancer in men worldwide. Radical prostatectomy and radiation beam therapy are the most common treatment options for localized prostate cancer and have different associated complications. The etiology of post prostatectomy incontinence is multifactorial. There is evidence in the literature that anatomic support and pelvic innervation are important factors in the etiology of post-prostatectomy incontinence. Among the many surgical and technical factors proposed in the literature, extensive dissection during surgery, damage to the neurovascular bundle and the development of postoperative fibrosis have a substantial negative impact on the continence status of men undergoing RP. Sparing of the bladder neck and anterior, and possibly posterior, fixation of the bladder-urethra anastomosis are associated with better continence rates. Overactive bladder syndrome (OAB) is multifactorial and the exact role of prostate surgery in the development of OAB is still under debate. There are several variables that could contribute to detrusor overactivity. Detrusor overactivity in patients after radical prostatectomy has been mainly attributed to a partial denervation of the bladder during surgery. However, together with bladder denervation, other hypotheses, such as the urethrovesical mechanism, have been described. Although there is conflicting evidence regarding the importance of conservative treatment after post-prostatectomy urinary incontinence, pelvic floor muscle training (PFMT) is still considered as the first treatment choice. Duloxetin, either alone or in combination with PFMT, may hasten recovery of urinary incontinence but is often associated with severe gastrointestinal and central nervous side effects. However, neither PFMT nor duloxetine may cure male stress urinary incontinence. The therapeutic decision and the chosen treatment option must be individualized for each patient according to clinical and social factors. During the recent years, the development of new therapeutic choices such as male sling techniques provided a more acceptable management pathway for less severe forms of urinary incontinence related to radical prostatectomy. Following this perspective, technological improvements and the emergence of new dedicated devices currently create the premises for a continuously positive evolution of clinical outcomes in this particular category of patients.
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Affiliation(s)
| | - Tom Marcelissen
- Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | | | - Manuela Tutolo
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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Ziegelmüller B, Bauer RM, Sommer A. [Urinary incontinence in men: causes, diagnostic steps and treatment options]. MMW Fortschr Med 2021; 163:62-69. [PMID: 33710573 DOI: 10.1007/s15006-021-9631-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Brigitte Ziegelmüller
- Urologische Klinik und Poliklinik,, Klinikum der Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, München, Germany
| | - Ricarda M Bauer
- Urologische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Germany
| | - Anne Sommer
- Urologische Klinik und Poliklinik,, Klinikum der Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, München, Germany
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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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Baunacke M, Groeben C, Borkowetz A, Uhlig A, Leitsmann M, Volkmer B, Thomas C, Huber J. [Health care reality of urological endoprosthetics in Germany from 2006 to 2016]. Urologe A 2021; 60:351-360. [PMID: 33481064 PMCID: PMC7979589 DOI: 10.1007/s00120-021-01444-5] [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] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
Hintergrund Die Behandlung von Harninkontinenz und erektiler Dysfunktion verbessert die Lebensqualität vieler Patienten. Insbesondere die Endoprothetik mit Sphinkter- und Penisprothesen erzielt hierbei sehr gute Ergebnisse, wenn konservative Therapieoptionen ausgeschöpft sind. Ziel dieser Studie ist eine Darstellung der Entwicklung und aktuellen Versorgungslage der Sphinkter- und Penisprothesenimplantation in Deutschland. Material und Methoden Wir führten eine Analyse der Diagnosis-Related-Groups-Abrechnungsdaten in Deutschland im Zeitraum von 2006 bis 2016 durch. Die Versorgungslage im Jahr 2016 beschrieben wir auf Basis der Qualitätsberichtsdaten der deutschen Krankenhäuser. Ergebnisse Von 2006 bis 2012 stieg die Zahl der implantierten Sphinkterprothesen in Deutschland von 739 auf 1112 (p < 0,001) und die Zahl der implantierenden Kliniken von 129 auf 206 (p < 0,001). Von 2012 bis 2016 fielen die Fallzahlen auf 980 und die Zahl der Kliniken auf 198. Im Jahr 2016 implantierten 168 (88 %) urologische Kliniken 1–9 Sphinkterprothesen und 23 (12 %) Kliniken ≥ 10 Sphinkterprothesen. Die 10 Top-Kliniken (≥20 Sphinkter) implantierten 34 % (283/839) aller Sphinkter. Von 2006 bis 2013 stieg die Zahl der implantierten Penisprothesen kontinuierlich von 263 auf 503 (p < 0,001) sowie die Zahl der implantierenden Kliniken von 71 auf 107 (p < 0,001). Von 2013 bis 2016 stagnierte die Fallzahl (p = 0,9) und die Zahl der implantierenden Kliniken (p = 0,5). Der Anteil implantierter Penisprothesen im Rahmen von Geschlechtsumwandlungen stieg von 17 % im Jahr 2006 auf 25 % im Jahr 2016 (p = 0,03). Im Jahr 2016 implantierten 83 (85 %) urologische Kliniken 1–6 Penisprothesen und 14 (15 %) Kliniken ≥ 7 Prothesen. Die 7 Top-Kliniken (≥20 Prothesen/Jahr) implantierten 232/448 (52 %) der Prothesen. Diskussion Der Versorgungsstand der urologischen Endoprothetik in Deutschland zeigt eine deutliche Zentrenbildung, aber auch eine große Zahl von Kliniken mit geringer Fallzahl. Seit 2012/2013 zeigt sich eine Stagnation der Fallzahlen von Penis- und Sphinkterprothesenimplantationen, die in Zusammenschau mit den Prostatektomiefallzahlen eine Unterversorgung vermuten lässt. Zusatzmaterial online Die Online-Version dieses Artikels (10.1007/s00120-021-01444-5) enthält weitere Tabellen zu Fallzahlen von Sphinkterprothesen und Penisprothesenimplantationen. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.
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Affiliation(s)
- Martin Baunacke
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Christer Groeben
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Angelika Borkowetz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Annemarie Uhlig
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Marianne Leitsmann
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Björn Volkmer
- Klinik für Urologie, Klinikum Kassel, Kassel, Deutschland
| | - Christian Thomas
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Johannes Huber
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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Esquinas C, Ruiz S, de Sancha E, Vazquez M, Dorado JF, Virseda M, Arance I, Angulo JC. Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter. Adv Ther 2021; 38:678-690. [PMID: 33230712 PMCID: PMC7854436 DOI: 10.1007/s12325-020-01563-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/04/2020] [Indexed: 12/26/2022]
Abstract
Introduction A prospective evaluation of outcomes in a series of patients with post-prostatectomy incontinence (PPI) treated with two different devices is presented. Methods Consecutive patients with PPI underwent interventions with an adjustable transobturator male system (ATOMS) or artificial urinary sphincter (AUS). Decisions were based on patient preference after physician counselling. Patient characteristics and operative and postoperative parameters including dryness, satisfaction, complications, revision and device durability were evaluated. Results One hundred twenty-nine patients were included: 102 (79.1%) received ATOMS and 27 (20.9%) AUS. Mean follow-up was 34.9 ± 15.9 months. No difference was observed between patient age (p = 0.56), ASA score (p = 0.13), Charlson index (p = 0.57) and radiation (p = 0.3). BMI was higher for AUS (27.1 vs. 29.7; p = 0.003) and also baseline incontinence severity (7.9% mild, 44.1% moderate and 48% severe for ATOMS vs. 11.1% moderate and 88.9% severe for AUS; p = 0.0007). Differential pad test was higher for AUS (− 470 vs. − 1000 ml; p < 0.0001) and so was ICIQ-SF (15.62 vs. 18.3; p < 0.001), but total dryness (76.5 vs. 66.7%; p = 0.33), social continence (90.2 vs. 85.2%; p = 0.49) and satisfaction (92.2 vs. 88.9%; p = 0.69) were equivalent. The postoperative complication rate was similar (22.6 vs. 29.6%; p = 0.4). The surgical revision rate was higher for AUS (6.9 vs. 22.2%; p = 0.029) and also the explant rate but did not reach statistical significance (4.9 vs. 14.8%; p = 0.09). Time to explant was shorter for AUS (log-rank p = 0.021). Regression analysis revealed radiation (p = 0.003) and incontinence severity (p = 0.029) predict total dryness, while complications (p < 0.005) and type of device (p = 0.039) independently predict surgical revision. Conclusions Both ATOMS and AUS are effective devices. Pad test change for AUS exceeds that of ATOMS. The revision rate is higher for AUS, and durability is superior for ATOMS. The satisfaction rate is equivalent. Larger series and longer follow-up are needed to compare both devices more appropriately. According to our experience, the AUS is not the only gold standard for PPI. Electronic supplementary material The online version of this article (10.1007/s12325-020-01563-z) contains supplementary material, which is available to authorized users.
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Angulo JC. Selecting the best candidate for a male incontinence device or another: dream or nightmare? Int Braz J Urol 2020; 47:423-425. [PMID: 33284546 PMCID: PMC7857742 DOI: 10.1590/s1677-5538.ibju.2020.0551.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Javier C Angulo
- Departamento Clínico, Universidad Europea de Madrid, Servicio de Urología, Hospital Universitario de Getafe, Madrid, Spain
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Ammirati E, Manassero A, Mosiello G, Falcone M, Geretto P, Giammò A. First experience with ATOMS system implant in neurogenic stress urinary incontinence. Neurourol Urodyn 2020; 39:1837-1841. [PMID: 32542976 DOI: 10.1002/nau.24433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/07/2022]
Abstract
AIM To evaluate efficacy and safety of ATOMS implant in neurogenic patients with stress incontinence performing clean intermittent catheterization (CIC). METHODS We included all patients with neurogenic sacral/subsacral lesion and stress urinary incontinence, treated with ATOMS implant between January 2018 and March 2019. All patients received anamnesis, 24-hour pad test and pad count, physical examination, video urodynamic evaluation, Qualiveen questionnaire. All patients were followed up at 12 months after implantation. Patients were considered "continent" when dry or when wearing a security pad (social continence). RESULTS We treated eight male patients with a median age of 25 years, four affected by myelomeningocele, and four by cauda equine syndrome. The median preoperative 24-hour pad test was 225 g (interquartile range [IQR]: 180-275). During the surgical procedure, we did not fill the cushion to prevent postoperative urethral injuries when performing CIC in the early postoperative time. At a 12-month follow-up, we had a significant reduction in postoperative 24-hour pad test (median value: 7.5 g; IQR: 0-16.25; P < .05). All patients reached continence. We had a significant reduction in the Qualiveen scores (P < .05). Patients demonstrated to be satisfied with the results of the intervention at the PGI-I questionnaire. The only complications were four cases of temporary scrotal edema (Clavien-Dindo 1) treated with conservative therapy. All patients resumed CIC without urethral traumatism nor catheter insertion difficulties. We had no cases of device infection nor device removal. CONCLUSIONS Implantation of ATOMS device seems to be an effective and safe minimally invasive procedure also in neurological patients with a low rate of postoperative complications.
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Affiliation(s)
- Enrico Ammirati
- Department of Neuro-Urology, CTO/Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alberto Manassero
- Department of Neuro-Urology, CTO/Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giovanni Mosiello
- Department of Neuro-Urology Pediatric, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Marco Falcone
- Department of Neuro-Urology, CTO/Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paolo Geretto
- Department of Neuro-Urology, CTO/Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandro Giammò
- Department of Neuro-Urology, CTO/Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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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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Virseda‐Chamorro M, Ruiz S, García G, Queissert F, Salinas J, Arance I, Angulo JC. Do voiding urodynamic parameters predict the success of adjustable transobturator male system (ATOMS) to treat postprostatectomy urinary incontinence? Neurourol Urodyn 2020; 39:1746-1752. [DOI: 10.1002/nau.24416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/24/2020] [Indexed: 01/07/2023]
Affiliation(s)
| | - Sonia Ruiz
- Department of UrologyHospital Universitario de Getafe Madrid Spain
| | - Gonzalo García
- Clinical Department, Faculty of Medical SciencesUniversidad Europea de Madrid Madrid Spain
| | - Fabian Queissert
- Department of Urology and Pediatric UrologyUniversity Hospital of Muenster Muenster Germany
| | - Jesús Salinas
- Department of UrologyHospital Clínico de San Carlos Madrid Spain
| | - Ignacio Arance
- Department of UrologyHospital Universitario de Getafe Madrid Spain
- Clinical Department, Faculty of Medical SciencesUniversidad Europea de Madrid Madrid Spain
| | - Javier C. Angulo
- Department of UrologyHospital Universitario de Getafe Madrid Spain
- Clinical Department, Faculty of Medical SciencesUniversidad Europea de Madrid Madrid Spain
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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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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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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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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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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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