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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Téllez C, Szczesniewski J, Virseda-Chamorro M, Arance I, Angulo JC. Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery. Curr Oncol 2023; 30:4153-4165. [PMID: 37185429 PMCID: PMC10136884 DOI: 10.3390/curroncol30040316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: The adjustable trans-obturator male system (ATOMS) is a surgical device developed to treat post-prostatectomy incontinence (PPI) after prostate cancer treatment. We review the current literature on this anti-incontinence device with the intention of assessing the effectiveness, safety and duration of the silicone-covered scrotal port (SSP) ATOMS, the only generation of the device that is currently available. (2) Material and Methods: Non-systematic literature review is performed. Forty-eight full-text articles are assessed for eligibility. Case reports, expert opinions or commentaries without specific data reported (n = 6), studies with patients who underwent intervention before 2014 (IP or SP ATOMS; n = 10), and studies with incontinence after transurethral resection of the prostate (TUR-P; n = 2) are excluded for analysis. Thirty studies with SSP ATOMS are included in a qualitative synthesis that incorporates systematic reviews (n = 3), articles partially overlapping with other previously published studies (e.g., follow-up or series updates; n = 9), and studies focusing on specific populations (n = 8). Only articles revealing outcomes of SSP ATOMS were included in the quantitative synthesis of results (n = 10). (3) Results: the pooled data of 1515 patients from the 10 studies with SSP ATOMS confirmed very satisfactory results with this device after adjustment: dry rate: 63-82%, improved rate: 85-100%, complication rate: 7-33%, device infection rate: 2.7-6.2% and explant rate: 0-19%. The durability of the device is reassuring, with 89% of devices in place 5 years after implantation. (4) Conclusion: Despite the absence of randomized controlled studies, the literature findings confirm results of SSP ATOMS appear equivalent to those of artificial urinary sphincters (AUSs) in terms of continence, satisfaction and complications, but with a lower rate of revision in the long-term. A prospective study identified that patients with daily pad test results <900 mL and a Male Stress Incontinence Grading Scale (MSIGS) of not 4 (i.e., early and persistent stream or urine loss) are the best candidates. Future studies centered on the elder population at higher risk of impaired cognitive ability and in patients including radiation as prostate cancer treatment are needed.
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Affiliation(s)
- Carlos Téllez
- Clinical Department, Faculty of Biomedical Sciences, Universidad Europea, 28805 Madrid, Spain
- Urology Department, Hospital Universitario de Getafe, 28805 Madrid, Spain
| | - Juliusz Szczesniewski
- Clinical Department, Faculty of Biomedical Sciences, Universidad Europea, 28805 Madrid, Spain
- Urology Department, Hospital Universitario de Getafe, 28805 Madrid, Spain
| | - Miguel Virseda-Chamorro
- Urology Department, Hospital Nacional de Parapléjicos, Carretera de la Peraleda, S/N, 45004 Toledo, Spain
| | - Ignacio Arance
- Clinical Department, Faculty of Biomedical Sciences, Universidad Europea, 28805 Madrid, Spain
- Urology Department, Hospital Universitario de Getafe, 28805 Madrid, Spain
| | - Javier C Angulo
- Clinical Department, Faculty of Biomedical Sciences, Universidad Europea, 28805 Madrid, Spain
- Urology Department, Hospital Universitario de Getafe, 28805 Madrid, Spain
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Ullate A, Arance I, Virseda-Chamorro M, Ruiz S, Szczesniewski J, Téllez C, Queissert F, Dorado JF, Angulo JC. ATOMS ( Adjustable Trans-Obturator Male System) in Patients with Post-Prostatectomy Incontinence and Previously Treated Urethral Stricture or Bladder Neck Contracture. J Clin Med 2022; 11. [PMID: 36013121 DOI: 10.3390/jcm11164882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: Male stress incontinence in patients with previously treated urethral or bladder neck stricture is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is unknown. (2) Methods: All patients with primary ATOMS implants in our institution between 2014 and 2021 were included. The outcomes of patients with previously treated urethral or bladder neck stricture (≥6 months before ATOMS implant) and stable 16Ch urethral caliber were compared to those without a history of stricture. The primary endpoint was the dry patient rate, defined as the pad test ≤ 20 mL/day, and complication rate, including device removal. The secondary variable was 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. (3) Results: One hundred and forty-nine consecutive patients were included, twenty-one (14%) previously treated for urethral or bladder neck stricture (seven urethroplasty, nine internal urethrotomy and five bladder neck incision). After ATOMS adjustment, 38% of the patients with treated stricture were continent compared to 83% of those without (p < 0.0001). After weighted matched observations using propensity score pairing, the proportion of continent patients without a previous stricture was 56% (p = 0.236). Complications occurred in 29% of the patients with stricture and in 20% of those without (p = 0.34). The severity of the complications was distributed evenly among the groups (p = 0.42). Regarding self-perceived satisfaction with the implant, 90% of the patients with stricture perceived the results satisfactorily (PGI-I 1−3) compared to 97% of the rest (p = 0.167). Stricture was associated with radiotherapy (p < 0.0001) and time from prostatectomy to implantation (p = 0.012). There was a moderate correlation between previous stricture and the severity of incontinence, both evaluated according to the 24-h pad test (Rho = 0.378; p < 0.0001) and the ICIQ-SF questionnaire (Rho = 0.351; p < 0.0001). Multivariate analysis for the factors predictive of failure after ATOMS adjustment revealed previous stricture (OR 4.66; 95% CI 1.2−18.87), baseline 24-h pad test (per 100 mL, OR 1.28; 95% CI 1.09−1.52) and final cushion volume (per mL, OR 1.34; 95% CI 1.19−1.55). This model predicted dryness with an AUC of 92%. After the PSMATCH procedure using a propensity score, the model remained unchanged, with the previous stricture (OR 8.05; 95% CI 1.08−110.83), baseline 24-h pad test (per 100 mL, OR 1.53; 95% CI 1.15−2.26) and final cushion volume (per mL, OR 1.45; 95% CI 1.17−2) being independent predictors and an AUC of 93%. (4) Conclusions: ATOMS can be used to treat male stress incontinence in patients with a history of stricture, although the effectiveness of the device is reduced. On the other hand, the security and perceived satisfaction were equivalent for both groups.
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