The Adjustable Transobturator Male System in Stress Urinary Incontinence After Transurethral Resection of the Prostate

Friedl, Alexander; Schneeweiss, J; Stangl, Kathrin; Mühlstädt, Sandra; Zachoval, Roman; Hruby, Stephan; Gründler, Therese; Kivaranovic, Danijel; Fornara, Paolo; Lusuardi, Lukas; Brössner, Clemens

doi:10.1016/j.urology.2017.07.004

Cited by 16 publications

(9 citation statements)

References 25 publications

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“…Also, ATOMS use in special populations should be better explored. All series include some degree of patients not previously undergoing prostatectomy, but only in two studies was ATOMS evaluated exclusively after TURP [25, 27]. Both studies present limited numbers of patients, but in general terms effectiveness results are comparable to those of SUI after prostatectomy.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Adjustable Transobturator Male System (ATOMS) to Treat Male Stress Incontinence: A Systematic Review and Meta-Analysis

Esquinas

Angulo

2018

Adv Ther

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IntroductionAdjustable transobturator male system (ATOMS) is a surgical device developed to treat male stress urinary incontinence (SUI) after prostate surgery. The objective was to assess the effectiveness of the ATOMS device to treat male SUI as described in the literature.MethodsTwo independent reviewers identified studies eligible for a systematic review and meta-analysis of various sources written in English, German and Spanish, using the databases PubMed, EMBASE and Web of Science. We excluded studies on female incontinence. We employed the DerSimonian and Laird method for defining heterogeneity, calculating the grouped standard mean deviation (SMD). The primary objective of this review is the assessment of clinical efficacy based on the achievement of dryness after device adjustment, defined as use of no pad or one safety pad per day (PPD). The secondary objective was focused on analysing improvement of incontinence with the device. Magnitude of effect was calculated by analysing decrease in pad count (PPD) and/or in 24-h pad test. Number and severity of complications according to Clavien–Dindo classification were also reviewed.ResultsThe pooled data of 1393 patients from 20 studies (13 retrospective and 7 prospective) showed that treatment with ATOMS resulted in a mean 67% dryness rate and 90% improvement after adjustment. Mean total number of system fillings per patient was 2.4. Mean pad count and 24-h pad test decrease were − 4.14 PPD and − 443 cc, respectively. There is significant heterogeneity of the sample analysed, mainly based on variable baseline severity of incontinence, proportion of patients treated with irradiation and different generation devices. Proportion of irradiated patients affected dryness rate (p = 0.0014), together with baseline severity of incontinence (p = 0.0035) and different generation device used (p < 0.0001). Standardized mean follow-up was 20.9 months, with complications occurring in 16.4% (major complications 3.0%) and explantations in 5.75%. No randomized study has been developed so far to compare ATOMS to other devices for treating male SUI.ConclusionDespite the evidence being exclusively based on descriptive studies and limited follow-up, ATOMS has proven to be a safe alternative to treat different degrees of male SUI after prostate surgery. Better results are evidenced for patients with less than 6 PPD before implantation, non-irradiated patients and use of third-generation device with silicone-covered pre-attached scrotal port.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0852-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Adjustable Transobturator Male System (ATOMS) to Treat Male Stress Incontinence: A Systematic Review and Meta-Analysis

Esquinas

Angulo

2018

Adv Ther

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confidence: 99%

“…2 While TURP has demonstrated its efficacy in improving urinary symptoms, acute safety concerns and long-term negative impacts such as erectile and ejaculatory dysfunction, possible incontinence as well as other associated complications have been well documented. 5 As an alternative to TURP, minimally invasive surgical therapies (MISTs) have emerged as options to relieve symptoms while minimizing or eliminating hospital stays and complications. 2 Rez umÔ water vapor thermal therapy (Rez um System, Boston Scientific, Marlborough, Massachusetts) is an innovative MIST cleared by the U.S. Food and Drug Administration in 2015 to reduce prostate tissue volume associated with BPH, including hyperplasia of the central zone and/or a middle lobe.…”

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confidence: 99%

Final 5-Year Outcomes of the Multicenter Randomized Sham-Controlled Trial of a Water Vapor Thermal Therapy for Treatment of Moderate to Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

et al. 2021

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Purpose:We present final 5-year outcomes of the multicenter randomized sham-controlled trial of a water vapor therapy (Rezūm™) for treatment of moderate to severe lower urinary tract symptoms due to benign prostatic hyperplasia.Materials and Methods:A total of 197 subjects >50 years of age with International Prostate Symptom Score ≥13, maximum flow rate ≤15 ml/second and prostate volume 30 to 80 cc were randomized and followed for 5 years. From the control arm of 61 subjects, a subset of 53 subjects requalified and after 3 months received treatment as part of the crossover group and were also followed for 5 years. The total number of vapor treatments to each lobe of the prostate was determined by length of prostatic urethra and included middle lobe treatment per physician discretion.Results:Significant improvement of lower urinary tract symptoms was observed at <3 months post-thermal therapy, remaining durable through 5 years in the treatment group (International Prostate Symptom Score reduced 48%, quality of life increased 45%, maximum flow rate improved 44%, Benign Prostatic Hyperplasia Impact Index decreased 48%). Surgical re-treatment rate was 4.4% with no reports of device or procedure related sexual dysfunction or sustained de novo erectile dysfunction. Results within the crossover group were similar through 5 years.Conclusions:Minimally invasive treatment with water vapor thermal therapy provides significant and durable symptom relief as well as flow rate improvements through 5 years, with low surgical re-treatment rates and without impacting sexual function. It is a versatile therapy, providing successful treatment to obstructive lateral and middle lobes.

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“…Nach einem medianen Follow-Up von 22 -34 Monaten und maximal 3 Adjustierungen be-trugen die Kontinenzraten 58 % (TURP) bzw. 50 % (palliative TURP), bei einer signifikanten Reduktion des mittleren Vorlagenverbrauchs [38].…”

Section: Adjustierbare Schlingensystemeunclassified

Belastungsinkontinenz nach operativer Therapie einer benignen Prostatahyperplasie: Konservative und operative Therapieoptionen

Kretschmer

Gratzke

2018

Aktuel Urol

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Persistent stress urinary incontinence following surgical treatment of bladder outlet obstruction based on benign prostate enlargement (BPE) occurs at an incidence of approximately 2.2 %, although incidence rates vary significantly between different surgical options. Current evidence on SUI treatment of BPE patients is usually based on postprostatectomy incontinence patient cohorts or small subgroup analyses of greater patient collectives. Studies that focus on SUI after surgical treatment of BPE are still rare. Based on the current low-level evidence, it can be assumed that pelvic floor muscle training, implantation of an adjustable male sling system and implantation of an artificial urinary sphincter may be equally effective in PPI and post-BPE patients. The implantation of a retrourethral transobturator male sling, however, seems to provide lower success rates compared to PPI patients.

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The Adjustable Transobturator Male System in Stress Urinary Incontinence After Transurethral Resection of the Prostate

Cited by 16 publications

References 25 publications

Effectiveness of Adjustable Transobturator Male System (ATOMS) to Treat Male Stress Incontinence: A Systematic Review and Meta-Analysis

Effectiveness of Adjustable Transobturator Male System (ATOMS) to Treat Male Stress Incontinence: A Systematic Review and Meta-Analysis

Final 5-Year Outcomes of the Multicenter Randomized Sham-Controlled Trial of a Water Vapor Thermal Therapy for Treatment of Moderate to Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

Belastungsinkontinenz nach operativer Therapie einer benignen Prostatahyperplasie: Konservative und operative Therapieoptionen

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