Objective
To identify risk factors for treatment failure of men with the adjustable transobturator
male system (ATOMS) for treating stress urinary incontinence (SUI).
Patients and Methods
Sixty-two patients with SUI after prostate surgery were provided with an ATOMS. The
self-defined criteria for treatment failure (implant removal [A], no improvement or
≥3 pads/24 hours [B], and no improvement or ≥150 mL urine loss/24 hours [C]) were
compared to anamnestic, clinical, and time-specific parameters: age, Charlson comorbidity
index (CCI), urine culture (UC), previous ineffective implants, body mass index, radiotherapy,
renal function (serum creatinine), smoker status, urethral strictures, SUI severity,
surgery time, time to and season at implantation, and port system application.
Results
After a median follow-up of 17.7 months, 9 ATOMS (15%) were removed due to infection
(8) or dysfunction (1); 23% and 16% had treatment failure of criteria B and C. Dry
rate/overall success rate was 61%/87%. Age alone was no risk factor but the CCI and
a positive UC were univariate significant predictors of the criteria A, B, and C.
Besides, previous devices and renal failure were significantly associated with implant
removal (A) and SUI severity with criterion C. In multivariate analysis, previous
devices (P = .0163), positive UC (P = .0190), and SUI severity (P = .0123) were the strongest predictors of A, B, and C, respectively.
Conclusion
A poor CCI, preoperative positive UC, severe SUI, and previous implants lead to more
treatment failure and removal. Age, body mass index, radiotherapy, urethral strictures,
current smoking, time-specific parameters, seasonality, and port system application
did not influence the outcome.
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Article info
Publication history
Published online: January 07, 2016
Accepted:
December 25,
2015
Received:
October 26,
2015
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
