Canadian Experience with the Adjustable Transobturator Male System for Post-Prostatectomy Incontinence: A Multicenter Study

Aim The aim of this study is to evaluate long‐term durability and effectiveness of the adjustable transobturator male system (ATOMS). Materials and Methods The retrospective multicenter Iberian ATOMS study (n = 215) was updated to evaluate long‐term continence status, complications, explants, and secondary treatments. Mean follow‐up from surgery to March 2020 was 60.6 ± 18.4 months (range, 39‐91). Eleven patients deceased of an unrelated causes. Kaplan‐Meier curves were performed to evaluate device durability and incontinence free of recurrence interval. The multivariate analysis defined the population at risk of device explant. Results A total of 155 patients were dry at the last follow‐up visit (72.1%); 99 (46%) used no pads and 56 (26%) used a security pad/day with urine loss less than 10 mL; 96% of dry patients after adjustment remained free of incontinence 1 year later, 93.6% 2 years later, 91.1% 3 years later, 89.2% 5 years later, and 86.7% 8 years later. Complications during follow‐up occurred in 43 of 215 (20%). In total, 25 (11.6%) devices were explanted and causes were inefficacy 11 (44%), inefficacy and pain 3 (12%), port erosion 10 (40%), and wound infection 1 (4%). The secondary implant was performed in 11 (5.1%) cases, 6 artificial urinary sphincter and 5 repeated ATOMS. Time to explant was associated to complications (P < .0001), baseline stress urinary incontinence (SUI) severity (P = .01), and former irradiation (P = .03). Multivariate analysis revealed complications (hazard ratio [HR] = 8.71; 3.83‐19.82), baseline SUI severity (>5 compared to 1‐2 pads/day; HR = 14.9; 1.87‐125), and irradiation before ATOMS (HR = 2.26; 1.02‐5.18) predicted earlier ATOMS explant. Three cases received radiation after implant without complication. Conclusions ATOMS device is efficacious and safe in the long term. Determinants for device explant include complications, baseline severity of incontinence, and previous irradiation. Currently, the durability of the device after 5 years is reassuring.

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 88%

Long‐term outcome of adjustable transobturator male system for stress urinary incontinence in the Iberian multicentre study

Angulo

Chamorro

Arance

et al. 2020

“…21 Unfortunately, as with any other incontinence prostheses, not all patients achieve urinary continence after device adjustment, and approximately 20% of the patients treated with last generation siliconecovered scrotal port ATOMS will remain incontinent to some degree. [8][9][10] Patients not achieving dryness can be very satisfied with their device but dryness after adjustment is a major factor to define PROs. 13 Baseline severity of SUI incontinence, former radiation, and secondary treatment have been identified by several authors as clinical determinants of treatment failure.…”

Section: Discussionmentioning

confidence: 99%

“…13 Baseline severity of SUI incontinence, former radiation, and secondary treatment have been identified by several authors as clinical determinants of treatment failure. [7][8][9] However, a more accurate definition of the optimal candidates for ATOMS implant remains a matter of current investigation.…”

Section: Discussionmentioning

confidence: 99%

“…6 Adjustable transobturator male system (ATOMS®, A.M.I., Feldkirch, Austria) has demonstrated its effectiveness for the treatment of PPI both in multicentre studies performed in Europe and Canada and meta-analysis. [7][8][9][10][11] Interestingly, patient-reported outcomes (PROs) with the device confirm a high level of satisfaction can be expected, but not all patients achieve continence after the implant. 12,13 Several clinical and urodynamic risk factors can be responsible for urinary incontinence persistence after surgical treatment of PPI but, due to their different mode of action, they may differ between surgical devices used.…”

Section: Introductionmentioning

confidence: 99%

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Do voiding urodynamic parameters predict the success of adjustable transobturator male system (ATOMS) to treat postprostatectomy urinary incontinence?

Chamorro

Ruiz

Garcia

et al. 2020

Objective To evaluate whether urodynamic voiding risk factors can be predictive of failure of postprostatectomy urinary incontinence (PPI) treatment with adjustable transobturator male system (ATOMS). Materials and Methods We carried out a longitudinal study on 77 males treated for PPI with ATOMS. Patients were submitted preoperatively to a urodynamic study. The postoperative outcome was checked by pad‐test. Treatment success was defined as daily pad‐test below 10 mL. Statistical analysis used were Fisher exact test, χ2 lineal by lineal test, Student t test, and logistic regression analysis. The signification level was set at 95% bilateral. Results Treatment was successful in 54 patients (70%) achieving continence. The urodynamic parameters that related to postoperative continence outcome were the cystometric bladder capacity (direct relationship with continence (P = .019), type of voiding (more probability to achieve continence in patients who voided voluntarily followed by patients with involuntary voiding and abdominal straining voiding) (P = .034), Bladder Outlet Obstruction Index (BOOI) (inversely related with continence) (P = .025), and maximum voiding abdominal pressure (inversely related with continence) (P = .049). Multivariate analysis showed that cystometric bladder capacity (odds ratio [OR], 1.01; confidence interval [CI], 1.02‐1.00), BOOI (OR, 0.97; CI, 0.99‐0.94), and maximum abdominal bladder pressure (OR, 0.97; CI, 0.98‐0.94) were independent risk factors to predict treatment success after ATOMS implant. Conclusions The study of functional voiding parameters is useful to know the risk factors that influence postoperative outcome of PPI with ATOMS device. These findings could be of primary importance to facilitate optimum patient selection for this implant and therefore improve operative results.

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

Angulo

Schönburg

Giammò

et al. 2021

Self Cite

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.