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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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Johnson A, Mossack S, Tsambarlis P. Artificial Urinary Sphincters for Moderate Post-Prostatectomy Incontinence: Current Research and Proposed Approach. Cancers (Basel) 2023; 15:4424. [PMID: 37760394 PMCID: PMC10526785 DOI: 10.3390/cancers15184424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Male urinary incontinence is a common complication after radical prostatectomy. The severity of incontinence can be assessed in various ways and helps determine the best surgical intervention to restore continence. While most patients with mild incontinence receive a sling and those with severe incontinence receive an artificial urinary sphincter (AUS), there are no clear guidelines on how to manage patients with moderate post-prostatectomy incontinence (PPI). Our discussion will focus on the current literature, which demonstrates that an AUS should be considered first-line in men with moderate PPI despite perceived concerns over complications and reintervention rates.
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Affiliation(s)
- Andrew Johnson
- Rush Medical College, Rush University, Chicago, IL 60612, USA;
| | - Spencer Mossack
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Peter Tsambarlis
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA;
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Smith WJ, VanDyke ME, Venishetty N, Langford BT, Franzen BP, Morey AF. Surgical Management of Male Stress Incontinence: Techniques, Indications, and Pearls for Success. Res Rep Urol 2023; 15:217-232. [PMID: 37366389 PMCID: PMC10290851 DOI: 10.2147/rru.s395359] [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: 02/01/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose Male stress urinary incontinence (SUI) has detrimental and long-lasting effects on patients. Management of this condition is an evolving field with multiple options for surgical treatment. We sought to review the pre-operative evaluation, intra-operative considerations, post-operative care, and future directions for treatment of male SUI. Methods A literature review was performed using the PubMed platform to identify peer-reviewed, English-language articles published within the last 5 years pertaining to management of male stress urinary incontinence with an emphasis on devices currently on the market in the United States including the artificial urinary sphincter (AUS), male urethral slings, and the ProACTTM system. Patient selection criteria, success rates, and complications were compared between the studies. Results Twenty articles were included in the final contemporary review. Pre-operative workup most commonly included demonstration of incontinence, PPD, and cystoscopy. Definition of success varied by study; the most common definition used was social continence (0-1 pads per day). Reported rates of success were higher for the AUS than for male urethral slings (73-93% vs 70-90%, respectively). Complications for these procedures include urinary retention, erosions, infections, and device malfunction. Newer treatment options including adjustable balloon systems and adjustable slings show promise but lack long-term follow-up. Conclusion Patient selection remains the primary consideration for surgical decision-making for management of male SUI. The AUS continues to be the gold standard for moderate-to-severe male SUI but comes with inherent risk of need for revision. Male slings may be a superior option for appropriately selected men with mild incontinence but are inferior to the AUS for moderate and severe incontinence. Ongoing research will shed light on long-term results for newer options such as the ProACT and REMEEX systems.
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Affiliation(s)
- Wesley J Smith
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maia E VanDyke
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nikit Venishetty
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brian T Langford
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bryce P Franzen
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Xiangyun L, Zhen L, Mengyao H, Lin Z, Xiaonan S, Jingxiong W, Chunhui L, Wenwen C, Weigang Y, Yancai L. Curative effect of pelvic floor muscle exercise on urinary incontinence after radical prostatectomy—Comparisons of different approaches at different time point. Andrologia 2022; 54:e14373. [PMID: 35279870 DOI: 10.1111/and.14373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lu Xiangyun
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Liang Zhen
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Hu Mengyao
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Zhou Lin
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Sun Xiaonan
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Wu Jingxiong
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Liu Chunhui
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Chen Wenwen
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Yan Weigang
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Liang Yancai
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
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Cho ST, Kim KH. Pelvic floor muscle exercise and training for coping with urinary incontinence. J Exerc Rehabil 2022; 17:379-387. [PMID: 35036386 PMCID: PMC8743604 DOI: 10.12965/jer.2142666.333] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/30/2021] [Indexed: 12/29/2022] Open
Abstract
The pelvic floor consists of levator ani muscles including puborectalis, pubococcygeus and iliococcygeus muscles, and coccygeus muscles. Pelvic floor muscle exercise (PFME) is defined as exercise to improve pelvic floor muscle strength, power, endurance, relaxation, or a combination of these parameters. PFME strengthens the pelvic floor muscles to provide urethral support to prevent urine leakage and suppress urgency. This exercise has been recommended for urinary incontinence since first described by Kegel. When treating urinary incontinence, particularly stress urinary incontinence, PFME has been recommended as first-line treatment. This article provides clinical application of PFME as a behavioral therapy for urinary incontinence. Clinicians and physical therapist should understand pelvic floor muscle anatomy, evaluation, regimen, and instruct patients how to train the muscles properly.
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Affiliation(s)
- Sung Tae Cho
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Khae Hawn Kim
- Department of Urology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Korea
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Khouri RK, Yi YA, Ortiz NM, Baumgarten AS, Ward EE, VanDyke ME, Hudak SJ, Morey AF. Standing cough test stratification of moderate male stress urinary incontinence. Int Braz J Urol 2021; 47:415-422. [PMID: 33284545 PMCID: PMC7857773 DOI: 10.1590/s1677-5538.ibju.2020.0551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Patient-reported history of pads per day (PPD) is widely recognized as a fundamental element of decision-making for anti-incontinence procedures. We hypothesize that SUI severity is often underestimated among men with moderate SUI. We sought to compare patient history of incontinence severity versus objective in-office physical examination findings. MATERIALS AND METHODS We retrospectively reviewed our single-surgeon male SUI surgical database from 2007-2019. We excluded patients with incomplete preoperative or postoperative data and those who reported either mild or severe SUI, thus having more straightforward surgical counseling. For men reported to have moderate SUI, we determined the frequency of upgrading SUI severity by recording the results of an in-office standing cough test (SCT) using the Male Stress Incontinence Grading Scale (MSIGS). The correlation of MSIGS with sling success rate was calculated. Failure was defined as >1 PPD usage or need for additional incontinence procedure. RESULTS Among 233 patients with reported moderate SUI (2-3 PPD), 89 (38%) had MSIGS 3-4 on SCT, indicating severe SUI. Among patients with 2-3 PPD preoperatively, sling success rates were significantly higher for patients with MSIGS 0-2 (76/116, 64%) compared to MSIGS 3-4 (6/18, 33%) (p <0.01). CONCLUSIONS Many men with self-reported history of moderate SUI actually present severe SUI observed on SCT. The SCT is a useful tool to stratify moderate SUI patients to more accurately predict sling success.
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Affiliation(s)
- Roger K. Khouri
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Yooni A. Yi
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Nicolas M. Ortiz
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Adam S. Baumgarten
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Ellen E. Ward
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Maia E. VanDyke
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Steven J. Hudak
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Allen F. Morey
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Correspondence address: Allen F. Morey, MD, Department of Urology, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA. 75390-9110 Telephone: + 1 214 648-0202 E-mail:
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Complications after male adjustable suburethral sling implantation. Wideochir Inne Tech Maloinwazyjne 2020; 15:496-502. [PMID: 32904554 PMCID: PMC7457203 DOI: 10.5114/aoms.2020.97413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Argus suburethral sling implantation is a minimally invasive operation with the possibility to adjust the tension of the sling at any time after the procedure, which provides good treatment results for male stress urinary incontinence (SUI). Aim To determine the predictive factors, the incidence, severity and timing of the onset of complications after Argus sling implantation for males with post-operative SUI. Material and methods A total of 41 patients who underwent Argus sling implantation due to post-operative SUI were included. Median follow-up was 12 months. All complications were captured and graded according to severity and classified by timing of onset. Logistic regression analysis was performed to identify predictors of the most common side effects. Results Overall 22 (54%) of 41 males have experienced 31 complications. Three (7%) patients have experienced only intra-operative, 16 (39%) patients only post-operative and 3 (7%) patients both intra-operative and post-operative complications. The most common intra-operative complications were bladder perforation (12%) and external iliac vein injury (5%), while post-operative complications were acute urinary retention (29%), infection (10%) and perineal pain (7%). Previous radiotherapy has significantly increased the risk of intra-operative complications, while a non-significant tendency was observed for younger age, previous androgen deprivation therapy and grade 3 SUI. In terms of severity, most post-operative complications were classified as grade 3 according to the modified Clavien-Dindo system. Conclusions Argus sling implantation provides a tolerable complication rate, where acute urinary retention was the most common side effect. Previous radiotherapy significantly increases the risk of serious intra-operative complications.
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Artificial Urinary Sphincter for Postradical Prostatectomy Urinary Incontinence - Is It the Best Option? Int Neurourol J 2019; 23:265-276. [PMID: 31905273 PMCID: PMC6944792 DOI: 10.5213/inj.1938210.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/13/2019] [Indexed: 01/13/2023] Open
Abstract
Male stress urinary incontinence (SUI) can undoubtedly reduce quality of life and promote personal distress and psychosocial alienation. The frequency of postprostatectomy urinary incontinence (PPI) counts on the characterization of urinary incontinence and the periods of patient follow-up. Operational therapeutics, for instance, urethral male slings and artificial urinary sphincters, are well-chosen as adequate and secure surgeries for male SUI in men with continual PPI when conservative treatment is ineffective. Over the former 2 decades, surgery has progressed regarding both operative approach and sling architecture. However, there are no guidelines about when surgery should be carried out and which is the most appropriate surgical option. In this review, we summarize recent advances in implantable devices for PPI and also discuss traditional surgical care. When we are planning the male PPI surgery, careful preoperative work-up should be performed and surgical method should be chosen according to the severity of the disease. Male sling is preferred in mild and moderate symptomatic patients with normal detrusor pressure and it is recommended to select traditional artificial urinary sphincter device in those with severe symptoms. It is expected that effective devices without adverse events will be developed with technical advances in near future.
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