Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and Adjustable Continence Therapy (ProACT) for male stress incontinence

Abstract

Background and purposeUrinary incontinence is one of the most serious complications of prostate cancer treatment. The objective of this study was to assess efficacy and safety of Adjustable Transobturator Male System (ATOMS) compared to Adjustable Continence Therapy (proACT) for male stress urinary incotinence according to literature findings.Material and methodsA systematic review and meta-analysis on adjustable devices ATOMS and ProACT is presented. Studies on female or neurogenic incontinence were excluded. Differences between ATOMS and proACT in primary objective: dryness status (no-pad or one safety pad/day) after initial device adjustment, and in secondary objectives: improvement, satisfaction, complications and device durability, were estimated using random-effect model. Statistical heterogeneity among studies included in the meta-analysis was assessed using tau2, Higgins´s I2 statistics and Cochran´s Q test.ResultsCombined data of 41 observational studies with 3059 patients showed higher dryness (68 vs. 55%; p = .01) and improvement (91 vs. 80%; p = .007) rate for ATOMS than ProACT. Mean pad-count (-4 vs. -2.5 pads/day; p = .005) and pad-test decrease (-425.7 vs. -211.4 cc; p < .0001) were also significantly lower. Satisfaction was higher for ATOMS (87 vs. 56%; p = .002) and explant rate was higher for proACT (5 vs. 24%; p < .0001). Complication rate for ProACT was also higher, but not statistically significant (17 vs. 26%; p = .07). Mean follow-up was 25.7 months, lower for ATOMS than ProACT (20.8 vs. 30.6 months; p = .02). The rate of working devices favoured ATOMS at 1-year (92 vs. 76; p < .0001), 2-years (85 vs. 61%; p = .0008) and 3-years (81 vs. 58%; p = .0001). Significant heterogeneity was evidenced, due to variable incontinence severity baseline, difficulties for a common reporting of complications, different number of adjustments and time of follow-up and absence of randomized studies.ConclusionsDespite the limitations that studies available are exclusively descriptive and the follow-up is limited, literature findings confirm ATOMS is more efficacious, with higher patient satisfaction and better durability than ProACT to treat male stress incontinence.

Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter

“…Of course, larger series with longer follow-up are required to better compare these devices. We believe adjustable devices should not be considered as a whole because the mode of action and also the efficacy and security profile differ among these devices [ 29 , 30 ].…”

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

“…For more severe situations including post-radiation, severe SUI, and failure of less invasive options, the artificial urinary sphincter (AUS) is the most frequently used device all over the world. 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.…”

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

“…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 9 . Indirect comparison with other adjustable systems such as ProACT or male REEMEX favored ATOMS, both in terms of effectiveness and safety 10,11 …”