Five-year experience with the adjustable transobturator male system for the treatment of male stress urinary incontinence: a single-center evaluation

Mühlstädt, Sandra; Friedl, Alexander; Mohammed, Nasreldin; Schumann, Anja; Weigand, K.; Kawan, Felix; Göllert, C.; Kahlert, Christin; Theil, Gerit; Fischer, Kersten; Fornara, Paolo

doi:10.1007/s00345-016-1839-x

Cited by 41 publications

(29 citation statements)

References 21 publications

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“…Importantly, based on current guidelines, there is no general recommendation for one particular adjustable male sling and surgical procedures should be based on individual patient factors as well as surgical skills. The functional outcomes in the current study are within the range of previously published results of other adjustable male slings such as ATOMS (A.M.I., Austria) 13 or REEMEX (Neomedic, Spain) 14 …”

Section: Discussionsupporting

confidence: 86%

Retropubic vs transobturator Argus adjustable male sling: Results from a multicenter study

Loertzer

Huesch

Kirschner‐Hermanns

et al. 2020

Neurourology and Urodynamics

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Aims To comparatively analyse outcomes after ARGUS classic and ArgusT adjustable male sling implantation in a real‐world setting. Methods Inclusion criteria encompassed: non‐neurogenic, moderate‐to‐severe stress urinary incontinence (≥2 pads), implantation of an ARGUS classic or ArgusT male sling between 2010 and 2012 in a high‐volume center (>150 previous implantations). Functional outcomes were assessed using daily pad usage, 24‐hour pad testing, and International Consultation on Incontinence (ICIQ‐SF) questionnaires. Continence was defined as zero pads per 24 hours. Complications were graded using Clavien‐Dindo scale. For multivariate analysis, binary logistic regression models were used (P < .05). Results A total of 106 patients (n = 74 [ARGUS classic], n = 32 [ArgusT]) from four centers were eligible. Median follow‐up was 44.0 months (24‐64). Patient cohorts were well‐balanced. We observed a statistical trend in favor of ARGUS classic regarding postoperative urine loss based on standardized 24‐hour pad test (71 ± 162 g [ARGUS classic] vs 160 ± 180 g [ArgusT]); P = .066]. Dry rates were 33.3% (ARGUS classic) and 11.8% (ArgusT, P = .114). In multivariable analysis, ArgusT male sling could not be confirmed as an independent predictor of decreased success (OR, 0.587; 95% CI; 0.166‐2.076, P = .408). There were no Clavien IV and V complications. Inguinal pain was significantly higher after ArgusT implantation (P = .033). Explantation rates were higher for ArgusT compared to ARGUS classic (14.0 vs 23.3%; P = .371). Longer device survival for the ARGUS classic male sling was observed in Kaplan‐Meier analysis (P = .198). Conclusions In the largest comparative analysis of ARGUS classic and ArgusT male sling with the longest follow‐up to date, we observed low continence rates with superior functional outcomes and decreased explantation rates after ARGUS classic implantation.

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Section: Discussionsupporting

confidence: 86%

Retropubic vs transobturator Argus adjustable male sling: Results from a multicenter study

Loertzer

Huesch

Kirschner‐Hermanns

et al. 2020

Neurourology and Urodynamics

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“…In the original clinical description of Seweryn et al [11], ATOMS system was presented as an excellent first-or second-line treatment for mild-to-moderate male SUI, even after external irradiation. Later a singlecenter experience confirmed that ATOMS represents an efficient alternative even for severe incontinence [29]. Also, patient-reported outcomes showed ATOMS is a well-appreciated option for SUI of any severity [12].…”

Section: Discussionmentioning

confidence: 69%

Adjustable Transobturator Male System after Failed Surgical Devices for Male Stress Urinary Incontinence: A Feasibility Study

et al. 2018

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Objectives: Feasibility study to evaluate the efficacy and safety of Adjustable Transobturator Male System (ATOMS) after failed surgical devices for male stress urinary incontinence (SUI). Materials and Methods: Thirty patients were implanted with ATOMS after they were implanted with surgical device/s previously. SUI severity was evaluated as dryness (0–1 pad/day), mild (2 pads/day), moderate (3–5 pads/day), or severe (≥6 pads/day). Change in pad-test and pad-count after adjustment, operative parameters, patient satisfaction, and number and grade of complications were investigated. Results: Previous failed treatment methods were artificial urinary sphincter (AUS; n = 19), Advance (n = 10), and Virtue (n = 1). Six cases had multiple previous treatments. Preoperative SUI was mild 6 (20%), moderate 11 (36.7%), and severe 13 (43.3%). Median pad-test decreased from 435 mL baseline to 10 mL after adjustment and pad-count from 4 to 0. Dry-rate was 76.7 and 83.3% declared satisfied. Postoperative SUI distribution was mild in 3 (10%) and moderate in 4 (13.3%). No patient had urinary retention after catheter removal. Complications presented in 4 (13.3%; 3 grade-I, 1 grade-II). After a median of 24 months follow-up, no system experienced infection or urethral erosion and 1 (3.3%) was removed for inefficacy. Conclusion: Based on short-term efficacy and patient satisfaction, ATOMS can be a realistic alternative for male SUI after other failed systems, including AUS. The absence of urethral erosion and limited infective problems makes this alternative attractive for cases with previous failed treatments.

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“…This information is important because the follow-up reported in most studies is scarce. Some reports on outcomes refer to long-term analysis but their median follow-up is only 2 to 3 years 9,19 and other multicentre studies give even less follow-up. 8,11,12 Also, information on long-term complications, device explant, and secondary treatments are necessary.…”

Section: Discussionmentioning

confidence: 99%

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

Angulo

Chamorro

Arance

et al. 2020

Neurourology and Urodynamics

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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.

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Five-year experience with the adjustable transobturator male system for the treatment of male stress urinary incontinence: a single-center evaluation

Abstract: The treatment of male SUI using the ATOMS incontinence system achieved the best results in patients with mild and moderate incontinence. For severe incontinent patients, the system represents an efficient alternative.

Cited by 41 publications

References 21 publications

Retropubic vs transobturator Argus adjustable male sling: Results from a multicenter study

Retropubic vs transobturator Argus adjustable male sling: Results from a multicenter study

Adjustable Transobturator Male System after Failed Surgical Devices for Male Stress Urinary Incontinence: A Feasibility Study

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

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