Compression or obstruction: Prospective analysis of the function of the adjustable transobturator male system (ATOMS) based on pre- and postoperative urodynamic data

Queissert, Fabian; Bruecher, Benedict; Ruiz, Sonia; Chamorro, M. Vírseda; Schrader, Andres Jan; Angulo, Javier

doi:10.5489/cuaj.7551

Cited by 4 publications

(5 citation statements)

References 12 publications

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“…e lack of considerable postoperative results in the selected studies in terms of pad weight does not consent to evaluate the effect of the different groups of devices on this parameter. More data are available in terms of number of pad/day, and in all groups, a significant (P < 0.01) mean reduction was observed after treatment, with the lowest improvement (−2.0 (95% CI −1.43/−2.57) pad/day) in the group of bulking agents and the highest (−5.19 (95% CI Van Uhm (39) Bauer (32) Bauer (31) Bauer (12) Ferro (29) Collado (15) Collado (14) Bauer (43) Renè Yiou (30) Cestari (40) Kim (34) Correira Lima (33) Renè Yiou ( Test of θ i = θ j : Q(0) = -0.00, p = .…”

Section: Advances In Urologymentioning

confidence: 87%

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Comparison of Different Invasive Devices for the Treatment of Urinary Incontinence after Radical Prostatectomy

Salciccia

Viscuso

Bevilacqua

et al. 2022

Advances in Urology

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Purpose. To compare different forms of invasive treatments for postradical prostatectomy (RP) urinary incontinence (UI) in terms of quantitative and qualitative parameters and continence recovery rate. Methods. We distinguished five categories of treatment: A = bulking agents, B = fixed slings, C = adjustable slings, D = circumferential compressor devices (artificial sphincter), and E = noncircumferential compressor devices (ProACT). A literature search was performed following the PRISMA guidelines. We performed a cumulative meta-analysis to explore the trend in the effect sizes across groups at postoperative follow-up. We compared the available treatment arms using standardized mean difference (SMD) and event rate (ER) for questionnaire results, number of pads/day, and percentage of pad-free patients. Evidence synthesis. 36 clinical trials were selected. At baseline, in the different populations, mean number of pad-day varied from 1.1 to 8.8, 24-hour pad weight varied extremely from 17.3 g to 747.0 g , and mean ICIQ-UI-SF questionnaire score varied from 4.8 to 18.6. Considering a random effect model among eligible studies, ER of continence recovery was 0.33 (95% CI −0.12–0.78), 0.63 (95% CI 0.55–0.71), 0.65 (95% CI 0.58–0.72), 0.50 (95% CI 0.34–0.66), and 0.53 (95%CI 0.36–0.70), respectively, in groups A, B, C, D, and E (I2 85.87%; Q 249.82— P > 0.01 ) (test of group differences P = 0.22 ). Conclusion. In our analysis, the use of adjustable and fixed slings is associated with the highest whereas the use of bulking agents is associated with the lowest recovery rate of continence after treatment. Results are conditioned by an elevated rate of heterogeneity in part explained with a high variability of consistence in urinary leakage at baseline among populations.

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Section: Advances In Urologymentioning

confidence: 87%

“…All 36 studies [ 9 – 43 ] were prospective mono- or multicenter clinical trials, and only 1 was randomized [ 9 ] ( Table 1 ).…”

Section: Evidence Synthesismentioning

confidence: 99%

Comparison of Different Invasive Devices for the Treatment of Urinary Incontinence after Radical Prostatectomy

Salciccia

Viscuso

Bevilacqua

et al. 2022

Advances in Urology

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“…Since 2009, the ATOM System has been used for the treatment of mild to moderate stress incontinence, but assumptions about its functioning have only been made in recent years. Virseda et al and Queissert et al have shown that the unilateral compression of the urethra does not result in obstructive micturition at normal adjusted volumes, and they concluded that the urethra can deflect in other directions due to the unilateral compression [ 8 , 9 ]. However, they did not provide any evidence for the assumption that indirect support of the membranous sphincter results from this.…”

Section: Discussionmentioning

confidence: 99%

A New Proximal Adjustable Sling ATOMS SSP® Implantation Technique with Focus on the Urethral Bulb: Lessons Learned from Revision Surgery

Queissert

Bruecher

Schrader

2023

JCM

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Background: Adjustable sling ATOMS-SSP results in ventral compression of the urethra with favorable results in the treatment of men with mild to moderate stress incontinence. However, with transobturator tunneling and mesh fixation, the surgeon has a range of options, which leads to different results and sometimes unfavorable positioning of the silicone cushion. Using retrograde urethrography (RUG), we identified ATOMS patients with considerable misplacement. We then modified the implantation technique when we performed the revision, and now present here our first experiences with this new surgical technique. Methods: Patients after ATOMS-SSP implantation at our clinic were systematically subjected to a RUG if incontinence persisted after adjustments. In case of unfavorable positioning, a revision was performed with the aim of achieving an idealized urethroproximal position of the silicone pad. During follow-up, a repeat RUG was performed, and both subjective and objective outcome parameters were recorded. Results: Four men met the above criteria and underwent revision with reimplantation using our new technique. All patients postoperatively experienced significantly improved continence. RUGs demonstrated an ideal ATOMS position immediately below the proximal bulbar urethra. Conclusions: Our proximal implantation technique, presented here for the first time, allows optimal positioning of the ATOMS SSP, which is reflected in the objective parameters and RUG. Its use in primary implantation should also be considered and an expansion to the indication of severe stress incontinence seems possible, but this should only be done in studies.

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“…We have recent urodynamic evidence that ATOMS placement does not cause obstruction itself during the voiding phase [ 19 , 20 ], but there is no specific study addressing the role of previous solved obstruction in patients receiving ATOMS. On the one hand, despite patients with stricture being at risk of disease recurrence that could impact the long-term functional results, we did not detect a case of stricture recurrence after a median follow-up of 51 months, provided stable urethral patency for at least 6 months was confirmed before ATOMS implant.…”

Section: Discussionmentioning

confidence: 99%

ATOMS (Adjustable Trans-Obturator Male System) in Patients with Post-Prostatectomy Incontinence and Previously Treated Urethral Stricture or Bladder Neck Contracture

Ullate

Arance

Chamorro

et al. 2022

JCM

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(1) Background: Male stress incontinence in patients with previously treated urethral or bladder neck stricture is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is unknown. (2) Methods: All patients with primary ATOMS implants in our institution between 2014 and 2021 were included. The outcomes of patients with previously treated urethral or bladder neck stricture (≥6 months before ATOMS implant) and stable 16Ch urethral caliber were compared to those without a history of stricture. The primary endpoint was the dry patient rate, defined as the pad test ≤ 20 mL/day, and complication rate, including device removal. The secondary variable was self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank sum test, Fisher’s exact test and logistic regression were performed. (3) Results: One hundred and forty-nine consecutive patients were included, twenty-one (14%) previously treated for urethral or bladder neck stricture (seven urethroplasty, nine internal urethrotomy and five bladder neck incision). After ATOMS adjustment, 38% of the patients with treated stricture were continent compared to 83% of those without (p < 0.0001). After weighted matched observations using propensity score pairing, the proportion of continent patients without a previous stricture was 56% (p = 0.236). Complications occurred in 29% of the patients with stricture and in 20% of those without (p = 0.34). The severity of the complications was distributed evenly among the groups (p = 0.42). Regarding self-perceived satisfaction with the implant, 90% of the patients with stricture perceived the results satisfactorily (PGI-I 1–3) compared to 97% of the rest (p = 0.167). Stricture was associated with radiotherapy (p < 0.0001) and time from prostatectomy to implantation (p = 0.012). There was a moderate correlation between previous stricture and the severity of incontinence, both evaluated according to the 24-h pad test (Rho = 0.378; p < 0.0001) and the ICIQ-SF questionnaire (Rho = 0.351; p < 0.0001). Multivariate analysis for the factors predictive of failure after ATOMS adjustment revealed previous stricture (OR 4.66; 95% CI 1.2–18.87), baseline 24-h pad test (per 100 mL, OR 1.28; 95% CI 1.09–1.52) and final cushion volume (per mL, OR 1.34; 95% CI 1.19–1.55). This model predicted dryness with an AUC of 92%. After the PSMATCH procedure using a propensity score, the model remained unchanged, with the previous stricture (OR 8.05; 95% CI 1.08–110.83), baseline 24-h pad test (per 100 mL, OR 1.53; 95% CI 1.15–2.26) and final cushion volume (per mL, OR 1.45; 95% CI 1.17–2) being independent predictors and an AUC of 93%. (4) Conclusions: ATOMS can be used to treat male stress incontinence in patients with a history of stricture, although the effectiveness of the device is reduced. On the other hand, the security and perceived satisfaction were equivalent for both groups.

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Compression or obstruction: Prospective analysis of the function of the adjustable transobturator male system (ATOMS) based on pre- and postoperative urodynamic data

Cited by 4 publications

References 12 publications

Comparison of Different Invasive Devices for the Treatment of Urinary Incontinence after Radical Prostatectomy

Comparison of Different Invasive Devices for the Treatment of Urinary Incontinence after Radical Prostatectomy

A New Proximal Adjustable Sling ATOMS SSP® Implantation Technique with Focus on the Urethral Bulb: Lessons Learned from Revision Surgery

ATOMS (Adjustable Trans-Obturator Male System) in Patients with Post-Prostatectomy Incontinence and Previously Treated Urethral Stricture or Bladder Neck Contracture

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