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

Queissert, Fabian; Rourke, Keith; Schönburg, Sandra; Giammò, Alessandro; Gonsior, Andreas; González-Enguita, C.; Romero, Antonio; Schrader, Andres Jan; Cruz, Francisco; Martins, Francisco E.; Dorado, Juan F.; Angulo, Javier C.

doi:10.3390/jcm11010081

Cited by 5 publications

(6 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some of the more recently published focus on different specific topics, such as urodynamics and a special population of patients. Among them, two studies evaluate the role of ATOMS after a failed AUS [ 14 ] and after failed retro-urethral sling [ 15 ]. Other studies specifically focus on complications and device durability.…”

Section: Atoms Resultsmentioning

confidence: 99%

“…Additionally, perceived satisfaction is very similar to that of patients without a history of stricture [ 42 ]. Taking these facts into account, SSP ATOMS remains a very interesting alternative to trans-corporeal AUSs for PPI in patients with a fragile urethra, i.e., patients with prior sling failure [ 15 ], former removal of an AUS [ 14 ] or previous urethroplasty [ 42 ]. Also, the dual implant of ATOMS and a penile prosthesis appears feasible and effective [ 43 ].…”

Section: Atoms Resultsmentioning

confidence: 99%

“…Unlike non-adjustable retrobulbar slings, the ATOMS can be an option even in radiated patients and also in selected patients with moderate and moderate-to-severe PPI, provided some residual sphincteric function exists [ 10 ]. ATOMS is an effective and safe second-line treatment option for recurrent urinary incontinence after implantation of an AdVance/AdVance XP fixed male sling [ 15 ].…”

Section: Post-prostatectomy Incontinence (Ppi) Treatment Optionsmentioning

confidence: 99%

See 2 more Smart Citations

Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery

et al. 2023

Self Cite

View full text Add to dashboard Cite

(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.

show abstract

Section: Atoms Resultsmentioning

confidence: 99%

Section: Atoms Resultsmentioning

confidence: 99%

Section: Post-prostatectomy Incontinence (Ppi) Treatment Optionsmentioning

confidence: 99%

See 1 more Smart Citation

Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…ATOMS provides an efficient alternative for both the first- and second-line treatments after other failed options [ 4 , 5 , 6 , 7 ]. This device is placed using a trans-obturator passage and positioned under the urethra in order to achieve ventral compression of the bulbar urethra ventrally.…”

Section: Introductionmentioning

confidence: 99%

“…The scrotal port connected to the sub-urethral cushion allows simple adjustments by percutaneous puncture through the scrotal skin, which can be done even years after the device was originally implanted. In general terms, ATOMS achieves better continence rates than other fixed male slings and lower complication rates than the AUS [ 2 , 6 ]. ATOMS can also be used after radiotherapy, although, in these cases, it is not as effective as in patients without radiation [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

ATOMS (Adjustable Trans-Obturator Male System) in Patients with Post-Prostatectomy Incontinence and Previously Treated Urethral Stricture or Bladder Neck Contracture

Ullate

Arance

Chamorro

et al. 2022

JCM

Self Cite

View full text Add to dashboard Cite

(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.

show abstract

The effectiveness of adjustable trans‐obturator male system (ATOMS) in radiated patients is reduced: A propensity score‐matched analysis

Angulo,

Giammò,

Queissert

et al. 2024

BJUI Compass

Self Cite

View full text Add to dashboard Cite

ObjectivesThis 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 methodsConsecutive 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.ResultsOf 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.ConclusionATOMS implantation significantly outperformed in patients without adjuvant radiation over radiated patients.

show abstract

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

Cited by 5 publications

References 26 publications

Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery

Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery

ATOMS (Adjustable Trans-Obturator Male System) in Patients with Post-Prostatectomy Incontinence and Previously Treated Urethral Stricture or Bladder Neck Contracture

The effectiveness of adjustable trans‐obturator male system (ATOMS) in radiated patients is reduced: A propensity score‐matched analysis

Contact Info

Product

Resources

About