Use of Surgery for Post-Prostatectomy Incontinence

Nelson, Marc; Dornbier, Ryan; Kirshenbaum, Eric; Eguia, Emanuel; Sweigert, Patrick J.; Baker, Marshall S.; Farooq, Ahmer; McVary, Kevin T.; Gonzalez, Chris M.; Gupta, Gopal N.; Bresler, Larissa

doi:10.1097/ju.0000000000000618

Cited by 36 publications

(33 citation statements)

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“…1 Approximately, 3% to 6% of patients receiving radical prostatectomy in different health care systems worldwide undergo subsequently surgery for male SUI, with 25% of them requiring multiple surgeries. [2][3][4] The actual proportion of cases experiencing moderate-to-severe SUI is estimated at 10% to 20%. 5 Efforts to increase the repair of refractory incontinence could greatly improve the patient quality of life.…”

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confidence: 99%

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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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confidence: 99%

“…5 Efforts to increase the repair of refractory incontinence could greatly improve the patient quality of life. 4 The choice of surgery for the treatment of SUI continues to be a challenge. Currently, implantable urethral slings are recommended for men with mild-to-moderate SUI.…”

mentioning

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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“…In this analysis of 29,287 men from the HealthCare Cost and Utilization Project Database for Florida who underwent radical prostatectomy Nelson et al (page 786) from Maywood, Illinois found that only 3.6% subsequently underwent either placement of an artificial urethral sphincter or urethral sling. 5 The median time to incontinence surgery was 23.5 months after radical prostatectomy. Whether this indicates underutilization of these procedures is uncertain.…”

Section: Surgery For Post-prostatectomy Incontinencementioning

confidence: 99%

This Month in Adult Urology

Smith¹

2020

Journal of Urology

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“…3,4 Repair of refractory incontinence could greatly improve QoL. 5 Surgical treatment of this type of incontinence is based on returning urethral sphincter function by artificial urinary sphincter (AUS) or male slings (adjustable or nonadjustable) that increase urethral rest pressure. 6 Adjustable transobturator male system (ATOMS®, A.M.I., Feldkirch, Austria) has demonstrated its effectiveness for the treatment of PPI both in multicentre studies performed in Europe and Canada and meta-analysis.…”

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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Use of Surgery for Post-Prostatectomy Incontinence

Cited by 36 publications

References 0 publications

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

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

This Month in Adult Urology

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

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