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

Abstract

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.

Influence of ATOMS implant on the voiding phase of patients with post‐prostatectomy urinary incontinence

“…However, unlike this, a study showed that patients with higher BOOI have less chance of being cured of their incontinence after ATOMS implantation. 22 Furthermore, most studies were unable to diagnose a BOO because they used BOOI, a parameter with an indeterminate region of values. This drawback does not occur with the URA parameter whose normal values are well determined.…”

“…Utomo et al 21 measured BOOI before and after implantation of the volume adjustable balloons proACT, and they observed a significant increase in BOOI only in patients with successful outcome. However, unlike this, a study showed that patients with higher BOOI have less chance of being cured of their incontinence after ATOMS implantation 22 . Furthermore, most studies were unable to diagnose a BOO because they used BOOI, a parameter with an indeterminate region of values.…”

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

“…In particular, adjustable slings that need no manipulation to overcome cognitive and dexterity issues and offer results approaching or even overtaking those of AUS are increasingly used 25–28 . Moreover, optimal patient selection based on functional voiding parameters may further improve the functional outcomes of the ATOMS device 29 . However, there is very limited experience upon the secondary use of ATOMS 30 .…”

“…[25][26][27][28] Moreover, optimal patient selection based on functional voiding parameters may further improve the functional outcomes of the ATOMS device. 29 However, there is very limited experience upon the secondary use of ATOMS. 30 Also, its explant rate is variable in the literature and ranges between 2% and 30.5%, according to follow-up length and the proportion of patients included with device generations other than the actual silicone-covered scrotal port (SSP).…”

The Mode of Action of Adjustable Transobturator Male System (ATOMS): Intraoperative Urethral Pressure Measurements

“…The ATOMS device is also advantageous over other adjustable systems, both for a diminished rate of complications compared to the male REEMEX system [6] and also for Uro 2021, 1 46 increased effectiveness and durability compared to ProACT [7]. However, its mode of action is not well understood and analyses using urodynamic studies are scarce [8]. Our hypothesis is that the compression produced by the cushion filling produces a stretching effect on the bulbar urethra that increases urethral resistance and enhances the residual sphincteric activity, and also that the different responses to serial filling of the cushion intraoperatively after ATOMS placement could help to define the patients with the best postoperative results.…”