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

Abstract

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.

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

“…On the other hand, de novo urge incontinence is typically a late complication, but an infrequent one (1.9%). This finding has been recently reported, 21 but studies with urodynamic data looking for obstruction and detrusor overactivity should better clarify the cause and significance of de novo OAB after ATOMS placement. One cannot ignore that the appearance of de novo OAB might simply represent the aging of the cohort.…”

The effectiveness of adjustable trans‐obturator male system (ATOMS) in radiated patients is reduced: A propensity score‐matched analysis

“…Previous studies with ATOMS have reported that irradiation is a risk factor for complications 28 and also for the development of de novo OAB symptoms 29 . However, the present study runs contrary to these observations, probably because the methodology we used allows a better comparison.…”

“…27 Previous studies with ATOMS have reported that irradiation is a risk factor for complications 28 and also for the development of de novo OAB symptoms. 29 However, the present study runs contrary to these observations, probably because the methodology we used allows a better comparison. In observational studies in which randomization is not possible, propensity score methods are used to reduce the bias in estimating treatment effects.…”

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

“…The fact, that preoperative maximum cystometric volume in both cases were lower than volume at 1 st DO in postoperative surgery let us assume, that preoperative DO could be underestimated due to early urine leakage. Schoenburg et al (14) found no de novo DO in their prospective study in 361 patients with an ATOMS. Open to debate is the fact that urodynamic testing was not done regularly in the preoperative phase and that the postoperative symptoms of an overactive bladder were initially recorded only via questionnaires.…”