An overview of the ATOMS generations: port types, functionality and risk factors

Mühlstädt, Sandra; Friedl, Alexander; Zachoval, Roman; Mohammed, Nasreldin; Schumann, Anja; Theil, Gerit; Fornara, Paolo

doi:10.1007/s00345-018-2548-4

Cited by 13 publications

(14 citation statements)

References 28 publications

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“…That is in accordance with the previous observation that SSP has higher effectiveness and diminished complications than previous generations. 6,14,20 Possibly, we could not confirm higher durability for this device generation because SSP port design is very predominant in this series.…”

Section: Discussionmentioning

confidence: 77%

“…14 We confirm that port erosion and secondary infection is the most severe longterm complication, almost always leading to explant. 14,20 However, wound dehiscence, wound infection, or incipient erosion of the port can be managed by early drainage and secondary suture, port replacement or even port sacrifice, and tube ligation if the patient is dry at the time of surgical exploration. Thereof early recognition and management of these complications is mandatory.…”

Section: Discussionmentioning

confidence: 99%

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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: 77%

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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“…The surgical treatment of male SUI is highly interesting but also challenging in functional urology. On the one hand, the patients are mostly severely impaired (4,8,9), on the other hand, different medical devices in addition to the artificial sphincter have been developed. The effectiveness of these devices for male SUI is dependent on the degree of incontinence and the condition of the patient.…”

Section: Discussionmentioning

confidence: 99%

“…The implantation of the adjustable transobturator urinary incontinence system (ATOMS, A.M.I., Agency for Medical Innovations, Feldkirch, Austria) to treat persistent male stress urinary incontinence (male SUI) is an established surgical procedure. Mid-and long-term follow-up data (1)(2)(3)(4)(5) as well as a meta-analysis of approximately 1,393 patients from 20 studies (13 retrospective and 7 prospective studies) have revealed a very good continence success rate, with 67% of patients achieving dryness and 23% of patients showing improvement (>50% improvement in incontinence compared to baseline) (6). Functionally, the ATOMS device generates suburethral compression by its sphincter cushion.…”

Section: Introductionmentioning

confidence: 99%

De novo OAB After ATOMS: An Underestimated Problem or a Rare Side Effect?

et al. 2019

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Background: The urinary incontinence system ATOMS (A.M.I., Austria) generates suburethral compression through its sphincter cushion. To what extent the ATOMS may lead to overactive bladder (OAB) symptoms or which risk factors for these symptoms exist remain unknown to date. We report on our multicentre evaluation on the prevalence, status, and therapy of OAB after ATOMS. Methods: Between 10/09 and 01/17, a total of 361 patients received an ATOMS device in Vienna and Halle. A prerequisite for surgery was persistent male stress urinary incontinence lasting at least 6 months after the primary intervention, as well as the failure of conservative treatment. Patients with a preoperative untreated anastomotic stricture or detrusor overactivity were excluded. In addition to continence and voiding parameters, patient's age, BMI, comorbidities, and pre-treatment strategies of the underlying disease and urinary incontinence were examined. If de novo OAB was present, urodynamics were used for further clarification. Statistical analysis was performed with GraphPad Prism 7 ® (GraphPad Software, Inc., La Jolla, USA), p < 0.05 considered significant. Results: OAB presented 18 patients (4.9%). Regarding the degree of urinary incontinence as well as uroflowmetry, residual volume and comorbidities, patients with an OAB showed no differences compared to patients without an OAB (p < 0.05). Only previous radiotherapy or urinary incontinence surgery and urethral stricture interventions resulted in statistically significant differences based on the bivariate analysis (p = 0.030, p = 0.006, p = 0.007). The consecutive postoperative urodynamics revealed a sensory OAB in 17 patients and a low-compliance bladder in a patient with newly diagnosed insulin-dependent type II diabetes mellitus. OAB was treated with a standard dose of antimuscarinic drugs and for the low-compliance bladder with botulinum toxin type A. Conclusion: OAB symptoms can occur after ATOMS implantation, but are rare and have no clear correlation to the incontinence device but rather are due to urinary incontinence-related underlying diseases and previous treatments.

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“…19 The device has evolved with changes regarding the design and pre-attachment of the port to allow fast and easy implant through a single perineal incision. 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.…”

Section: Discussionmentioning

confidence: 99%

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

Chamorro

Ruiz

Garcia

et al. 2020

Neurourology and Urodynamics

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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.

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An overview of the ATOMS generations: port types, functionality and risk factors

Cited by 13 publications

References 28 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

De novo OAB After ATOMS: An Underestimated Problem or a Rare Side Effect?

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

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