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Angulo JC, Giammò A, Queissert F, Schönburg S, González‐Enguita C, Gonsior A, Romero A, Martins FE, Antunes‐Lopes T, González R, Szczesniewski J, Téllez C, Cruz F, Rourke KF. The effectiveness of adjustable trans-obturator male system (ATOMS) in radiated patients is reduced: A propensity score-matched analysis. BJUI COMPASS 2024; 5:506-514. [PMID: 38633825 PMCID: PMC11019248 DOI: 10.1002/bco2.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/24/2023] [Accepted: 12/21/2023] [Indexed: 04/19/2024] Open
Abstract
Objectives This study aimed to compare the effectiveness and safety of the adjustable trans-obturator male system (ATOMS®) to treat post-prostatectomy incontinence (PPI) in radiated patients compared with non-radiated patients, using propensity score-matching analysis to enhance the validity of the comparison. Patients and methods Consecutive men with PPI treated with silicone-covered scrotal port ATOMS (A.M.I., Feldkirch, Austria) in nine different institutions between 2016 and 2022 were included. Preoperative assessment evaluated 24-h pad usage, urethroscopy and urodynamics, if indicated. Propensity score-matching analysis was based on age, length of follow-up, previous PPI treatment, previous bladder neck stricture, androgen deprivation and pad usage. The primary endpoint was dry rate, defined as no pads post-operatively with a security pad allowed. The secondary endpoints were complications, device removal and self-perceived satisfaction with the Patient Global Impression of Improvement (PGI-I) scale. Results Of the 710 included patients, 342 were matched, and the study groups were balanced for the baseline matched variables. The mean baseline 24-h pad was 4.8 in both groups (p = 0.48). The mean follow-up was 27.5 ± 18.6 months, which was also equivalent between groups (p = 0.36). The primary outcome was achieved in 73 (42.7%) radiated patients and in 115 (67.3%) non-radiated patients (p < 0.0001). The mean pad count at the last follow-up was 1.5 and 0.8, respectively (p < 0.0001). There was no significant difference in complications (p = 0.94), but surgical revision and device explant rates were higher (p = 0.03 and p = 0.01, respectively), and the proportion of patients highly satisfied (PGI-I = 1) was lower in the radiated group (p = 0.01). At sensitivity analysis, the study was found to be reasonably robust to hidden bias. Conclusion ATOMS implantation significantly outperformed in patients without adjuvant radiation over radiated patients.
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Affiliation(s)
- Javier C. Angulo
- Clinical Department, Faculty of Biomedical ScienceUniversidad EuropeaMadridSpain
- Department of UrologyHospital Universitario de GetafeMadridSpain
| | - Alessandro Giammò
- Department of Neuro‐Urology, CTO/Spinal Cord UnitAOU Città della Salute e della Scienza di TorinoTurinItaly
| | - Fabian Queissert
- Department of Urology and Pediatric UrologyUniversity Hospital MuensterMünsterGermany
| | - Sandra Schönburg
- Department of Urology and Kidney TransplantationMartin Luther UniversityHalle (Saale)Germany
| | | | - Andreas Gonsior
- Klinik und Poliklinik für UrologieUniversity of LeipzigLeipzigGermany
| | - Antonio Romero
- Department of UrologyHospital Universitario Morales MeseguerMurciaSpain
| | - Francisco E. Martins
- Department of UrologyCentro Hospitalar Universitário de Lisboa Norte, Hospital Santa MaríaLisbonPortugal
| | - Tiago Antunes‐Lopes
- Department of UrologyCentro Hospitalar São JoãoPortoPortugal
- Faculty of Medicine of PortoI3S InstitutePortoPortugal
| | - Raquel González
- Department of UrologyHospital Fundación Jiménez DíazMadridSpain
| | | | - Carlos Téllez
- Clinical Department, Faculty of Biomedical ScienceUniversidad EuropeaMadridSpain
- Department of UrologyHospital Universitario de GetafeMadridSpain
| | - Francisco Cruz
- Department of UrologyCentro Hospitalar São JoãoPortoPortugal
- Faculty of Medicine of PortoI3S InstitutePortoPortugal
| | - Keith F. Rourke
- Department of UrologyAlberta University, Hospital EdmontonEdmontonAlbertaCanada
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Dirk K, Rourke KF. Health-related Quality of Life in Patients With Urethral Stenosis After Radiation Treatment for Prostate Cancer. Urology 2024; 185:109-115. [PMID: 38160763 DOI: 10.1016/j.urology.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To evaluate patient-reported quality of life (PRQoL) in patients presenting with membranous urethral stenosis after prostate radiotherapy. Urethral stenosis is an under-reported complication after prostate radiotherapy with a particular deficiency in PRQoL. METHODS Patients presenting with urethral stenosis after radiotherapy were retrospectively reviewed from 2004 to 2022. PRQoL was assessed via patient survey using the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). RESULTS Two hundred thirty patients were identified at a mean age of 67.7years and mean time to stricture diagnosis of 63.6months' postradiotherapy. Of 87 patients completing the survey, 29.9% recalled being aware of urethral stenosis as a potential complication and 51.7% had documentation of urethral stenosis as a potential complication. 33.5% of patients underwent urethroplasty, 59.6% repeat endoscopic treatment and 6.1% an indwelling catheter. 64.4% of patients reported urinary dysfunction as a "moderate" or "big" problem, 66.7% reported frequent or total incontinence, 64.4% required daily pad use and 50.6% reported incontinence as either a "moderate" or "big" problem. 85.0% reported poor or absent orgasmic dysfunction and 88.5% reported erections insufficient for sexual activity. Additionally, 47.1% of patients reported rectal pain and 31.0% reported dysuria. Depressive symptoms and fatigue were reported by 41.4% and 60.9% of patients respectively. CONCLUSION Urethral stenosis after radiotherapy is a clinically complex entity with a broad scope of associated symptoms including high rates of patient-reported incontinence, voiding dysfunction, sexual dysfunction, pain, bowel dysfunction and depression. This multifocal nature combined with often insidious presentation and patient unawareness creates a uniquely challenging condition to treat.
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Affiliation(s)
- Kennedy Dirk
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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Angulo JC, Téllez C, Giammò A, González-Enguita C, Schoenburg S, Queissert F, Szczesniewski J, González R, Romero A, Gonsior A, Martins FE, Antunes-Lopes T, Cruz F, Rourke K. Results of Adjustable Trans-Obturator Male System in Patients with Prostate Cancer Treated with Prostatectomy and Radiotherapy: A Multicenter Study. J Clin Med 2023; 12:4721. [PMID: 37510835 PMCID: PMC10380664 DOI: 10.3390/jcm12144721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Treatment of male stress incontinence in patients with prostate cancer treated with radical prostatectomy and adjuvant pelvic radiation is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is not well established, despite the general belief that outcomes are worse than in patients without radiation. (2) Methods: Retrospective multicenter study evaluating patients treated with silicone-covered scrotal port (SSP) ATOMS implant after radical prostatectomy and radiotherapy in nine different institutions between 2016 and 2022. The primary endpoint was dry patient rate, defined as pad-test ≤ 20 mL/day. The secondary endpoints were complication rate (defined using Clavien-Dindo classification), device removal and self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank-sum test, Fisher's exact test and logistic regression were performed using stepwise method with a 0.15 entry and 0.1 stay criteria. (3) Results: 223 patients fulfilled the criteria for inclusion and 12 (5.4%) received salvage prostatectomy after radiation and 27 (12.1%) previous devices for stress incontinence. After ATOMS adjustment, 95 patients (42.6%) were dry and 36 (16.1%) had complications of any grade (grade I, n = 20; grade II, n = 11; grade III, n = 5) during the first 3 months postoperatively. At a mean of 36 ± 21 months follow-up, the device was explanted in 26 (11.7%) patients. Regarding self-perceived satisfaction with the implant, 105 of 125 patients (84%) considered themselves satisfied (PGI-I 1 to 3). In the univariate analysis, dryness was associated to younger age (p = 0.06), primary prostatectomy (p = 0.08), no previous incontinence surgery (p = 0.02), absence of overactive bladder symptoms (p = 0.04), absence of bladder neck stricture (p = 0.001), no need of surgical revision (p = 0.008) and lower baseline incontinence severity (p = 0.0003). Multivariate analysis identified absence of surgical revision (p = 0.018), absence of bladder neck stricture (p = 0.05), primary prostatectomy (p = 0.07) and lower baseline incontinence severity (p < 0.0001) were independent predictors of dryness. A logistic regression model was proposed and internally validated. (4) Conclusions: ATOMS is an efficacious and safe alternative to treat male incontinence after radical prostatectomy and adjuvant radiotherapy. Factors predictive of dryness are identified in this complex scenario to allow for better patient selection.
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Affiliation(s)
- Javier C Angulo
- Clinical Department, Faculty of Biomedical Science, Universidad Europea, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
- Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
| | - Carlos Téllez
- Clinical Department, Faculty of Biomedical Science, Universidad Europea, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
- Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
| | - Alessandro Giammò
- Department of Neuro-Urology, CTO/Spinal Cord Unit, AOU Città Della Salute e Della Scienza di Torino, Via Zuretti 24, 10126 Torino, Italy
| | - Carmen González-Enguita
- Department of Urology, Hospital Fundación Jiménez Díaz, Av. de Los Reyes Católicos, 2, 28040 Madrid, Spain
| | - Sandra Schoenburg
- Department of Urology and Kidney Transplantation, Martin Luther University, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Fabian Queissert
- Department of Urology and Pediatric Urology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Juliusz Szczesniewski
- Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
| | - Raquel González
- Department of Urology, Hospital Fundación Jiménez Díaz, Av. de Los Reyes Católicos, 2, 28040 Madrid, Spain
| | - Antonio Romero
- Department of Urology, Hospital Universitario Morales Meseguer, Avd. Marqués de Los Vélez s/n., 30008 Murcia, Spain
| | - Andreas Gonsior
- Klinik und Poliklinik für Urologie, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Francisco E Martins
- Department of Urology, Centro Hospitalar Universitário de Lisboa Norte, Hospital Santa María, Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal
| | - Tiago Antunes-Lopes
- Department of Urology, Centro Hospitalar São João and Faculty of Medicine of University Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- I3S Institute, R. Alfredo Allen 208, 4200-135 Porto, Portugal
| | - Francisco Cruz
- Department of Urology, Centro Hospitalar São João and Faculty of Medicine of University Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- I3S Institute, R. Alfredo Allen 208, 4200-135 Porto, Portugal
| | - Keith Rourke
- Department of Urology, Alberta University, Hospital Edmonton, 8440 112 St. NW, Edmonton, AB T6G 2B7, Canada
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