Portal de Periódicos da CAPES

Canadian Experience with the Adjustable Transobturator Male System for Post-Prostatectomy Incontinence: A Multicenter Study

2019; Lippincott Williams & Wilkins; Volume: 202; Issue: 5 Linguagem: Inglês

10.1097/ju.0000000000000420

1527-3792

R. Christopher Doiron, Álvaro Saavedra, Trevor Haines, Geneviève Nadeau, Le-Mai Tu, Julie Morisset, Stephen Steele, Luc Valiquette, Dean Elterman, Conrad Maciejewski, Keith Rourke,

Reconstructive Surgery and Microvascular Techniques

No AccessJournal of UrologyAdult Urology1 Nov 2019Canadian Experience with the Adjustable Transobturator Male System for Post-Prostatectomy Incontinence: A Multicenter StudyThis article is commented on by the following:Editorial CommentEditorial Comment R. Christopher Doiron, Alvaro Saavedra, Trevor Haines, Genevieve Nadeau, Le-Mai Tu, Julie Morisset, Stephen Steele, Luc Valiquette, Dean Elterman, Conrad Maciejewski, and Keith Rourke R. Christopher DoironR. Christopher Doiron Divisions of Urology, University of Alberta, Edmonton, Alberta, Canada More articles by this author , Alvaro SaavedraAlvaro Saavedra Divisions of Urology, University of Alberta, Edmonton, Alberta, Canada More articles by this author , Trevor HainesTrevor Haines Divisions of Urology, University of Alberta, Edmonton, Alberta, Canada More articles by this author , Genevieve NadeauGenevieve Nadeau Université Laval, Quebec City, Canada Financial interest and/or other relationship with Red Leaf Medical. More articles by this author , Le-Mai TuLe-Mai Tu University of Sherbrooke, Sherbrooke, Quebec, Canada More articles by this author , Julie MorissetJulie Morisset Université de Montréal en Mauricie, Trois-Rivières, Quebec, Canada More articles by this author , Stephen SteeleStephen Steele Department of Urology, Queen’s University, Kingston, Ontario, Canada More articles by this author , Luc ValiquetteLuc Valiquette Université de Montréal, Montréal, Quebec, Canada More articles by this author , Dean EltermanDean Elterman University of Toronto, Toronto, Canada More articles by this author , Conrad MaciejewskiConrad Maciejewski University of Ottawa, Ottawa, Canada More articles by this author , and Keith RourkeKeith Rourke Correspondence: Division of Urology, Department of Surgery, University of Alberta, 7th Floor, Kaye Edmonton Clinic, 11400 University Ave., Edmonton, Alberta T6G-1Z1, Canada telephone: 780-407-5800; FAX: 780-441-2597; E-mail Address: [email protected] Divisions of Urology, University of Alberta, Edmonton, Alberta, Canada Financial interest and/or other relationship with Red Leaf Medical. More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000420AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assessed the efficacy and safety profile of the ATOMS® (Adjustable Transobturator Male System) for post-prostatectomy incontinence in a multicenter North American setting. Materials and Methods: We reviewed outcomes from 8 centers in men who underwent treatment of post-prostatectomy incontinence with an ATOMS. Primary study outcomes were pad changes and continence, defined as requiring 1.0 or 0 pad postoperatively in patients who required 2.0 or more pads preoperatively and 0 pad in those who required more than 1.0 or 2.0 pads preoperatively. Secondary outcomes included improvement, 90-day complications and patient satisfaction. Results: A total of 160 patients were enrolled in study with a median followup of 9.0 months. Preoperative median pad use was 4 per day (IQR 3–5). Of the patients 36.3% reported severe preoperative incontinence, 31.3% received prior radiotherapy and 16.3% underwent previous incontinence surgery. Median postoperative pad use after adjustments was 0.5 per day (IQR 0–1, p <0.001). The overall continence rate was 80.0% with improvement in 87.8% of cases. Of the patients 70.1% underwent a mean ± SD of 2.4 ± 2.7 adjustments (IQR 0–16). The patient satisfaction rate was 86.3%, 22.3% experienced 90-day complications of any grade and 7 (4.4%) experienced Clavien III complications primarily related to the injection port. Patients with a history of radiotherapy were less likely to be continent (62.5% vs 87.9%, p=0.002), improved (77.1% vs 92.6%, p=0.02) or satisfied (69.8% vs 93.2%, p=0.001). Similarly patients with previous incontinence surgery had lower rates of continence, improvement and satisfaction (57.7%, 73.1% and 69.6%, respectively). Conclusions: In the short term the ATOMS is a safe and efficacious device to treat post-prostatectomy incontinence. Patients with concurrent radiotherapy and previous incontinence surgery respond to treatment but are less likely to be continent, improved or satisfied. References 1. : Health related quality of life significance of single pad urinary incontinence following radical prostatectomy. J Urol 2003; 170: 512. Link, Google Scholar 2. : Committee of the International Consultation on Incontinence: surgical treatment of stress incontinence in men. Neurourol Urodyn 2010; 29: 179. Google Scholar 3. : Population based study of long-term rates of surgery for urinary incontinence after radical prostatectomy for prostate cancer. J Urol 2012; 188: 502. Link, Google Scholar 4. : An artificial sphincter; a new device and operation for control of enuresis and urinary incontinence. J Urol 1947; 58: 250. Link, Google Scholar 5. : Montreal electronic artificial urinary sphincters: our futuristic alternatives to the AMS800™. Can Urol Assoc J 2017; 11: E396. Google Scholar 6. : 13 Years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol 2007; 177: 1021. Link, Google Scholar 7. : Long-term durability and functional outcomes among patients with artificial urinary sphincters: a 10-year retrospective review from the University of Michigan. J Urol 2008; 179: 1912. Link, Google Scholar 8. : The artificial urinary sphincter for post-radical prostatectomy incontinence: impact on urinary symptoms and quality of life. J Urol 1996; 155: 1260. Link, Google Scholar 9. : Post-prostatectomy incontinence and the artificial urinary sphincter: a long-term study of patient satisfaction and criteria for success. J Urol 1996; 156: 1975. Link, Google Scholar 10. : Artificial urinary sphincter versus male sling for post-prostatectomy incontinence—what do patients choose?J Urol 2009; 181: 1231. Link, Google Scholar 11. : Stemming the tide of mild to moderate post-prostatectomy incontinence: a retrospective comparison of transobturator male slings and the artificial urinary sphincter. Can Urol Assoc J 2014; 8: 273. Google Scholar 12. : The self-anchoring transobturator male sling to treat stress urinary incontinence in men: a new sling, a surgical approach and anatomical findings in a cadaveric study. BJU Int 2005; 95: 1364. Google Scholar 13. : Initial experience and results with a new adjustable transobturator male system for the treatment of stress urinary incontinence. J Urol 2012; 187: 956. Link, Google Scholar 14. : Early results of a European multicenter experience with a new self-anchoring adjustable transobturator system for treatment of stress urinary incontinence in men. BJU Int 2012; 111: 296. Google Scholar 15. : Treatment of male stress urinary incontinence with the adjustable transobturator male system: outcomes of a multi-center Iberian study. Neurourol Urodyn 2018; 37: 1458. Google Scholar 16. : Long-term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study. BJU Int 2017; 119: 785. Google Scholar 17. : A transobturator adjustable system for male incontinence: 30-month follow-up of a multicenter study. Int Braz J Urol 2014; 40: 781. Google Scholar 18. : Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205. Google Scholar 19. : Reconstructive surgery for male stress urinary incontinence: experiences using the ATOMS® system at a single center. GMS Interdiscip Plast Reconstr Surg DGPW 2014; 3: Doc15. Google Scholar 20. : Is the adjustable transobturator system ATOMS useful for the treatment of male urinary incontinence in low to medium volume urological centers?Actas Urol Esp 2018; 42: 267. Google Scholar 21. : Single-centre experience in using the adjustable transobturator male system in treatment of stress urinary incontinence in patients after radical prostatectomy. J Clin Urol 2017; 71: 822. Google Scholar 22. : Effectiveness of adjustable transobturator male system (ATOMS) to treat male stress incontinence: a systematic review and meta-analysis. Adv Ther 2019; 36: 426. Google Scholar 23. : First experience with the ATOMS implant, a new treatment option for male urinary incontinence. Cent Eur J Urol 2014; 67: 387. Google Scholar 24. : Artificial urinary sphincter implantation in the irradiated patient: safety, efficacy and satisfaction. BJU Int 2002; 89: 364. Google Scholar 25. : Complications after artificial urinary sphincter implantation in patients with or without prior radiotherapy. BJU Int 2015; 115: 300. Google Scholar 26. : Mid-term outcomes of a male retro-urethral, transobturator synthetic sling for treatment of post-prostatectomy incontinence: impact of radiotherapy and storage dysfunction. Neurourol Urodyn 2017; 36: 1147. Google Scholar 27. : Advance male sling in irradiated patients with stress urinary incontinence. Can J Urol 2011; 18: 6013. Google Scholar 28. : Efficacy and safety of artificial urinary sphincter (AUS): results of a large multi-institutional cohort of patients with mid-term follow-up. Neurourol Urodyn 2019; 38: 710. Google Scholar 29. : Artificial urinary sphincter placement in compromised urethras and survival: a comparison of virgin, radiated and reoperative cases. J Urol 2014; 192: 1756. Link, Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. The ATOMS® device manufacturer, Agency for Medical Innovations, Feldkirch, Austria, was not involved with trial funding, execution or analysis, or with manuscript preparation. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology9 Oct 2019Editorial CommentJournal of Urology9 Oct 2019Editorial Comment Volume 202Issue 5November 2019Page: 1022-1028Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordsstressprostheses and implantsmaleurethraprostatectomyurinary incontinenceAcknowledgmentThe AUS was introduced by American Medical System Holdings, Inc., Hopkins, Minnesota.MetricsAuthor Information R. Christopher Doiron Divisions of Urology, University of Alberta, Edmonton, Alberta, Canada More articles by this author Alvaro Saavedra Divisions of Urology, University of Alberta, Edmonton, Alberta, Canada More articles by this author Trevor Haines Divisions of Urology, University of Alberta, Edmonton, Alberta, Canada More articles by this author Genevieve Nadeau Université Laval, Quebec City, Canada Financial interest and/or other relationship with Red Leaf Medical. More articles by this author Le-Mai Tu University of Sherbrooke, Sherbrooke, Quebec, Canada More articles by this author Julie Morisset Université de Montréal en Mauricie, Trois-Rivières, Quebec, Canada More articles by this author Stephen Steele Department of Urology, Queen’s University, Kingston, Ontario, Canada More articles by this author Luc Valiquette Université de Montréal, Montréal, Quebec, Canada More articles by this author Dean Elterman University of Toronto, Toronto, Canada More articles by this author Conrad Maciejewski University of Ottawa, Ottawa, Canada More articles by this author Keith Rourke Divisions of Urology, University of Alberta, Edmonton, Alberta, Canada Correspondence: Division of Urology, Department of Surgery, University of Alberta, 7th Floor, Kaye Edmonton Clinic, 11400 University Ave., Edmonton, Alberta T6G-1Z1, Canada telephone: 780-407-5800; FAX: 780-441-2597; E-mail Address: [email protected] Financial interest and/or other relationship with Red Leaf Medical. More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. The ATOMS® device manufacturer, Agency for Medical Innovations, Feldkirch, Austria, was not involved with trial funding, execution or analysis, or with manuscript preparation. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF downloadLoading ...