Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: An italian multicentric study

Giammò, Alessandro; Ammirati, Enrico; Morgia, Giuseppe; Sandri, S; Introini, Carlo; Canepa, G; Timossi, Luca; Rossi, Cristina; Mozzi, C.; Carone, Roberto

doi:10.1016/s1569-9056(18)33196-8

Cited by 3 publications

(4 citation statements)

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“…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. Another strength of this study is that the last generation device which is now in use (SSP) is predominant in this cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, the adjustable sling transobturator male system (ATOMS; A.M.I., Feldkirch, Austria) has been implanted for all degrees of SUI with positive outcomes both in meta-analysis 6,7 and multicentre studies performed in Europe and Canada. [8][9][10][11][12] Also, the excellent patient-reported outcomes and limited complications have been specifically reported recently. 13,14 However, ATOMS follow-up data are limited to less than 3 years.…”

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confidence: 89%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 89%

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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“…Several multicentre studies performed in Europe and Canada give conclusive evidence that ATOMS is an effective option to treat postprostatectomy incontinence. [1][2][3][4][5] Also, patient-reported outcomes support its use. [6][7][8] A systematic review and meta-analysis regarding published data revealed that treatment with ATOMS resulted in 67% dryness, 90% improvement, and 5.8% explant at a standardized mean follow-up of 20.9 months.…”

Section: Introductionmentioning

confidence: 94%

“…It requires no manipulation by the patient and can be adjusted postoperatively in the office by simple port injection without the need for anesthesia. Several multicentre studies performed in Europe and Canada give conclusive evidence that ATOMS is an effective option to treat post‐prostatectomy incontinence 1–5 . Also, patient‐reported outcomes support its use 6–8 .…”

Section: Introductionmentioning

confidence: 98%

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

Neurourology and Urodynamics

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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.

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Dual implantation of penile prosthesis and ATOMS® system for post-prostatectomy erectile dysfunction and urinary incontinence: a feasibility study

Falcone

Preto²,

Ammirati

et al. 2020

Int J Impot Res

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Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: An italian multicentric study

Cited by 3 publications

References 0 publications

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

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

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

Dual implantation of penile prosthesis and ATOMS® system for post-prostatectomy erectile dysfunction and urinary incontinence: a feasibility study

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