Advertisement

Multicentered Assessment of Clinical Outcomes and Factors Associated With Failure of the Adjustable TransObturator Male System (ATOMS)

Published:November 09, 2020DOI:https://doi.org/10.1016/j.urology.2020.09.045

      Objective

      To assess postoperative outcomes from the Adjustable TransObturator Male System (ATOMS) and identify factors influencing failure to achieve continence.

      Patients and Methods

      A multicentered analysis was performed on all patients treated for postprostatectomy incontinence using the third-generation ATOMS at 9 Canadian tertiary referral centers. The primary outcome was continence (defined as requiring ≤1 pad postoperatively for patients requiring ≥2 pads preoperatively and 0 pads for those requiring 1 pad preoperatively). Secondary outcomes included improvement (>50% change in pad use), patient satisfaction, explantation, and postoperative complications.

      Results

      Two hundred and eighty nine patients with a mean age of 68.9 years were analyzed. Pre-operatively mean pad per day use was 4.2 (1-12), 31.5% of patients reported severe incontinence (≥5 pads/day), 33.9% had concurrent radiotherapy and 19.4% had failed previous incontinence surgery. Overall continence rate was 73.3% (n = 212) at a mean follow-up of 19.6 months. More than eighty nine percent (89.3%) (n = 258) of patients experienced >50% improvement, 84.4% (n = 244) of patients were satisfied with the results of surgery. More than seven percent (7.9%) (n = 23) required device explantation. On multivariate Cox regression analysis, concurrent radiotherapy (hazard ratio [H.R.] 2.3, P < .001), diabetes (H.R. 2.2, P = .007) and increased pre-operative pad usage (H.R. 1.1, P = .02) were each associated with failure to achieve continence, while patient age (P = .60), obesity (P = .08), prior urethral stenosis (P = .56), and prior incontinence surgery (P = .13) were not. Radiation therapy was also associated with device explantation (H.R. 2.7, P = .02).

      Conclusion

      ATOMS is a safe and efficacious for treatment of postprostatectomy incontinence. However, patients with prior radiation, increased pre-operative pad use, or diabetes are less likely to achieve continence.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Herschorn S
        The artificial urinary sphincter is the treatment of choice for post-radical prostatectomy incontinence.
        Can Urol Assoc J. 2008; 2: 536-539
        • Van der Aa F
        • Drake
        • Kasyan MJ
        • Petrolekas GR
        • Cornu A
        • Young Academic Urologists Functional Urology JN
        The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence.
        Eur Urol. 2013; 63: 681-689
        • Ratan H
        • Summerton DJ
        • Wilson SK
        • Terry TR
        Development and current status of the AMS 800 artificial urinary sphincter.
        EAU-EBU Update Series. 2006; 4: 117-128
        • Meisterhofer K
        • Herzog S
        • Strini KA
        • et al.
        Male slings for postprostatectomy incontinence: a systematic review and meta-analysis.
        Eur Urol Focus. 2019; 15: 575-592
        • Seweryn J
        • Bauer W
        • Ponholzer A
        • Schramek P
        Initial experience and results with a new adjustable transobturator male system for the treatment of stress urinary incontinence.
        J Urol. 2012; 187: 956-961
        • Krause J
        • Tietze S
        • Behrendt W
        • Nast J
        • Hamza A
        Reconstructive surgery for male stress urinary incontinence: experiences using the ATOMS® system at a single center.
        GMS Interdiscip Plast Reconstr Surg DGPW. 2014; 3 (PMID: 26504726; PMCID: PMC4582500)https://doi.org/10.3205/iprs000056
        • Friedl A
        • Mühlstädt S
        • Zachoval R
        • et al.
        Long-term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study.
        BJU Int. 2017; 119: 785-792
        • Angulo JC
        • Arance I
        • Esquinas C
        • et al.
        Outcome measures of adjustable transobturator male system with pre-attached scrotal port for male stress urinary incontinence after radical prostatectomy: a prospective study.
        Adv Ther. 2017; 34: 1173
        • Léon P
        • Chartier‐Kastler E
        • Rouprêt M
        • et al.
        Long‐term functional outcomes after artificial urinary sphincter implantation in men with stress urinary incontinence.
        BJU international. 2015; 115: 951-957
        • Bauer RM
        • Soljanik I
        • Füllhase C
        • et al.
        Mid-term results for the retroluminar transobturator sling suspension for stress urinary incontinence after prostatectomy.
        BJU Int. 2011; 108: 94-98
        • Cornu JN
        • Sèbe P
        • Ciofu C
        • et al.
        The AdVance transobturator male sling for postprostatectomy incontinence: clinical results of a prospective evaluation after a minimum follow-up of 6 months.
        Eur Urol. 2009; 56: 923-927
        • Castle EP
        • Andrews PE
        • Itano N
        • et al.
        The male sling for post-prostatectomy incontinence: mean followup of 18 months.
        J Urol. 2005; 173: 1657
        • Schaeffer AJ
        • Clemens JQ
        • Ferrari M
        • Stamey TA
        The male bulbourethral sling procedure for post-radical prostatectomy incontinence.
        J Urol. 1998; 159: 1510
        • González SP
        • Cansino JR
        • Portilla MA
        • et al.
        First experience with the ATOMS® implant, a new treatment option for male urinary incontinence.
        Cent European J Urol. 2014; 67: 387
        • Bauer W.
        Adjustable transobturator male system – ATOMS – for the treatment of post–prostatectomy urinary incontinence: The surgical technique.
        Pelviperineology. 2011; 30: 10
        • Hoda MR
        • Primus G
        • Schumann A
        • et al.
        Behandlung der Belastungsinkontinenz nach radikaler Prostatektomie.
        Urologe. 2012; 51: 1576-1583
        • Kretschmer A.
        • Husch T.
        • Thomsen F.
        • et al.
        Efficacy and safety of the ZSI375 artificial urinary sphincter for male stress urinary incontinence: lessons learned.
        World J Urol. 2016; 34: 1457-1463
        • Crivellaro S
        • Morlacco A
        • Bodo G
        • et al.
        Systematic review of surgical treatment of post radical prostatectomy stress urinary incontinence.
        Neurourol Urodyn. 2016; 35: 875-881
        • Kretschmer A
        • Nitti V.
        Surgical treatment of male postprostatectomy incontinence: current concepts.
        Eur Urol Focus. 2017; 3: 364-376
        • Rehder P
        • Haab F
        • Cornu JN
        • Gozzi C
        • Bauer RM
        Treatment of postprostatectomy male urinary incontinence with the transobturator retroluminal repositioning sling suspension: 3-year follow-up.
        Eur Urol. 2012; 62: 140-145
        • Cornel E.B.
        Argus-T adjustable male sling: the influence of surgical technique on complications and short-term efficacy.
        Urol Int. 2016; 96: 164-170
        • Siracusano S.
        • Visalli F.
        • Favro M.
        • et al.
        Argus-T sling in 182 male patients: short-term results of a multicenter study.
        Urology. 2017; 110: 177-183
        • Dalpiaz O.
        • Knopf H.J.
        • Orth S.
        • et al.
        Mid-term complications after placement of the male adjustable suburethral sling: a single center experience.
        J Urol. 2011; 186: 604-609
        • Hubner W.A.
        • Gallistl H.
        • Rutkowski M.
        • Huber E.R.
        Adjustable bulbourethral male sling: experience after 101 cases of moderate-to-severe male stress urinary incontinence.
        BJU Int. 2011; 107: 777-782
        • McCall A.N.
        • Rivera M.E.
        • Elliott D.S.
        Long-term follow-up of the virtue quadratic male sling.
        Urology. 2016; 93: 213-216
        • Linder B.J.
        • Rivera M.E.
        • Ziegelmann M.J.
        • Elliott D.S
        Long-term outcomes following artificial urinary sphincter placement: an analysis of 1082 cases at Mayo Clinic.
        Urology. 2015; 86: 602-607
        • Nitti VW
        • Mourtzinos A
        • Brucker BM
        Correlation of patient perception of pad use with objective degree of incontinence measured by pad test in men with post-prostatectomy incontinence: the SUFU Pad Test Study.
        J Urol. 2014; 192: 836-842