Patient satisfaction with adjustable transobturator male system in the Iberian multicenter study

Angulo, Javier C.; Arance, I.; Ojea, A; Carballo, Manuel; Rodríguez, Andrés Mauricio Quevedo; Pereira, Javier; Rebassa, M.; Teyrouz, Antoine; Escribano, G; Teba, Fernando; Madurga, Blanca; Martins, Francisco E.; Cruz, Francisco

doi:10.1007/s00345-019-02639-4

Cited by 17 publications

(17 citation statements)

References 30 publications

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“…In addition, for the urinary incontinence system ATOMS in particular, only evidence on the risk factors for a therapeutic failure and information on patient satisfaction can be found. Friedl et al (3) found that patients with primary ATOMS implantation and without previous radiotherapy have a better therapeutic outcome, while Angulo et al (34) showed that patient satisfaction correlates positively with postoperative dryness (p < 0.0001), lower urinary incontinence (p = 0.007), less postoperative pain (p = 0.0018) and a lack of complications (p = 0.007).…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Initial outcomes regarding clinical effectiveness and patient-reported outcomes were reported in 2017. 10,13 All patients were updated to March 2020, except for 11 cases deceased of an unrelated cause.…”

Section: Subjectsmentioning

confidence: 99%

“…[8][9][10][11][12] Also, the excellent patient-reported outcomes and limited complications have been specifically reported recently. 13,14 However, ATOMS follow-up data are limited to less than 3 years. 9,10 Although the system is not prone to mechanical failure, the durability of the device in the long term is unknown.…”

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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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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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“…[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. 13 Baseline severity of SUI incontinence, former radiation, and secondary treatment have been identified by several authors as clinical determinants of treatment failure. [7][8][9] However, a more accurate definition of the optimal candidates for ATOMS implant remains a matter of current investigation.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11] Interestingly, patient-reported outcomes (PROs) with the device confirm a high level of satisfaction can be expected, but not all patients achieve continence after the implant. 12,13 Several clinical and urodynamic risk factors can be responsible for urinary incontinence persistence after surgical treatment of PPI but, due to their different mode of action, they may differ between surgical devices used. For AUS, persistence of urethral sphincter dysfunction and urodynamic filling phase disorders, like diminished bladder compliance and higher detrusor overactivity (DO) pressure, have been proposed as determinants for failure of surgical treatment of PPI and persistent incontinence.…”

Section: Introductionmentioning

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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Patient satisfaction with adjustable transobturator male system in the Iberian multicenter study

Cited by 17 publications

References 30 publications

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

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

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

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

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