Pd39-10 Urinary Retention After Advance® Sling: A Multi-Institutional Retrospective Study

Abstract

Incontinence related to sphincter weakness is a potential complication of radical prostatectomy. The ATOMS (Adjustable Trans-Obturator Male System) is selfanchoring trans-obturator device, which features a non-circumferential adjustable hydraulic cushion first introduced to Canada in 2014. We aim to assess the efficacy and safety of the ATOMS sling in a multi-centered setting.METHODS: We reviewed postoperative outcomes from 8 Canadian centers in male patients undergoing treatment with ATOMS for post-prostatectomy incontinence. The primary outcomes were mean pad change and continence defined as requiring 1 pad postoperatively for patients requiring 2 pads preoperatively, and 0 pads for those requiring 1 pad preoperatively. Secondary outcomes included patient satisfaction, improvement, and 90-day complications. Other patient demographics including age, obesity (BMI35), comorbidities, concurrent radiotherapy, previous incontinence surgery, previous urethral stenosis and type of prostatectomy were also examined. Improvement in continence (mean change and absolute change in pads/day) were calculated with t-tests. Patient satisfaction, continence and surgical complications were evaluated with descriptive statistics and Chi-square.RESULTS: A total of 160 patients with a mean age of 70.5 years were enrolled with a mean follow-up of 9.5 months. Pre-operatively mean pad use was 4.4 pads/day (1-10). Initial post-operative pad use was 1.5 pads/day (0-6) before cushion adjustment (p<0.0001) and 0.9 pads/day (0-6) following adjustments (p<0.0001). 58.3% patients underwent adjustment with a mean of 1.4 adjustments (0-7) for a total mean volume of 11.3 mL (0-31). Overall continence rate was 80.0% while 87.8% of patients experienced >50% improvement and 86.3% of patients were satisfied with the results of surgery. Although patients with concurrent radiotherapy did not differ by pre-operative pad usage (4.6 vs. 4.1; p¼0.17) they were less likely to be continent (62.5% vs. 87.9%; p<0.0001), improved (77.1% vs. 92.6%; p¼0.01) and satisfied (69.8% vs. 93.2%; p<0.0001). 22.3% (n¼35) of patients experienced 90-day complications (any Clavien grade) mostly Clavien I (17.8%) with 4.4% (n¼7) of patients experiencing Clavien III complications primarily related to the injection port.CONCLUSIONS: The ATOMS is a safe and efficacious device for the treatment of post prostatectomy incontinence even in the setting of severe incontinence. Patients with concurrent radiotherapy respond to treatment but are less likely to be continent, improved or satisfied.