Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter.
Adjustable transobturator male system
Artificial urinary sphincter
Effectiveness
Post-prostatectomy incontinence
Safety
Urology
Journal
Advances in therapy
ISSN: 1865-8652
Titre abrégé: Adv Ther
Pays: United States
ID NLM: 8611864
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
10
10
2020
accepted:
04
11
2020
pubmed:
25
11
2020
medline:
15
4
2021
entrez:
24
11
2020
Statut:
ppublish
Résumé
A prospective evaluation of outcomes in a series of patients with post-prostatectomy incontinence (PPI) treated with two different devices is presented. Consecutive patients with PPI underwent interventions with an adjustable transobturator male system (ATOMS) or artificial urinary sphincter (AUS). Decisions were based on patient preference after physician counselling. Patient characteristics and operative and postoperative parameters including dryness, satisfaction, complications, revision and device durability were evaluated. One hundred twenty-nine patients were included: 102 (79.1%) received ATOMS and 27 (20.9%) AUS. Mean follow-up was 34.9 ± 15.9 months. No difference was observed between patient age (p = 0.56), ASA score (p = 0.13), Charlson index (p = 0.57) and radiation (p = 0.3). BMI was higher for AUS (27.1 vs. 29.7; p = 0.003) and also baseline incontinence severity (7.9% mild, 44.1% moderate and 48% severe for ATOMS vs. 11.1% moderate and 88.9% severe for AUS; p = 0.0007). Differential pad test was higher for AUS (- 470 vs. - 1000 ml; p < 0.0001) and so was ICIQ-SF (15.62 vs. 18.3; p < 0.001), but total dryness (76.5 vs. 66.7%; p = 0.33), social continence (90.2 vs. 85.2%; p = 0.49) and satisfaction (92.2 vs. 88.9%; p = 0.69) were equivalent. The postoperative complication rate was similar (22.6 vs. 29.6%; p = 0.4). The surgical revision rate was higher for AUS (6.9 vs. 22.2%; p = 0.029) and also the explant rate but did not reach statistical significance (4.9 vs. 14.8%; p = 0.09). Time to explant was shorter for AUS (log-rank p = 0.021). Regression analysis revealed radiation (p = 0.003) and incontinence severity (p = 0.029) predict total dryness, while complications (p < 0.005) and type of device (p = 0.039) independently predict surgical revision. Both ATOMS and AUS are effective devices. Pad test change for AUS exceeds that of ATOMS. The revision rate is higher for AUS, and durability is superior for ATOMS. The satisfaction rate is equivalent. Larger series and longer follow-up are needed to compare both devices more appropriately. According to our experience, the AUS is not the only gold standard for PPI.
Identifiants
pubmed: 33230712
doi: 10.1007/s12325-020-01563-z
pii: 10.1007/s12325-020-01563-z
pmc: PMC7854436
doi:
Types de publication
Journal Article
Langues
eng
Pagination
678-690Références
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70:7–30.
doi: 10.3322/caac.21590
Averbeck MA, Marcelissen T, Anding R, Rahnama’i MS, Sahai A, Tubaro A. How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence-Research Society 2018. Neurourol Urodyn. 2019;38(Suppl 5):S119–26.
pubmed: 31821626
Linder BJ, Viers BR, Ziegelmann MJ, Rivera ME, Rangel LJ, Elliott DS. Artificial urinary sphincter mechanical failures—is it better to replace the entire device or just the malfunctioning component? J Urol. 2016;195:1523–8.
doi: 10.1016/j.juro.2015.10.084
Linder BJ, Rivera ME, Ziegelmann MJ, Elliott DS. Long-term outcomes following artificial urinary sphincter placement: an analysis of 1082 cases at Mayo Clinic. Urology. 2015;86:602–7.
doi: 10.1016/j.urology.2015.05.029
Van der Aa F, Drake MJ, Kasyan GR, Petrolekas A, Cornu JN, Young Academic Urologists Functional Urology Group. The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence. Eur Urol. 2013;63:681–9.
doi: 10.1016/j.eururo.2012.11.034
Tutolo M, Cornu JN, Bauer RM, Ahyai S, Bozzini G, Heesakkers J, Drake MJ, Tikkinen KAO, Launonen E, Larré S, Thiruchelvam N, Lee R, Li P, Favro M, Zaffuto E, Bachmann A, Martinez-Salamanca JI, Pichon T, De Nunzio C, Ammirati E, Haab F, Van Der Aa F. 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;38:710–8.
doi: 10.1002/nau.23901
Kretschmer A, Hübner W, Sandhu JS, Bauer RM. Evaluation and management of postprostatectomy incontinence: a systematic review of current literature. Eur Urol Focus. 2016;2:245–59.
doi: 10.1016/j.euf.2016.01.002
Angulo J, Arance I, Esquinas C, Dorado J, Marcelino J, Martins F. Outcome measures of adjustable transobturator male system with pre-attached scrotal port for male stress urinary incontinence after radical prostatectomy. Adv Ther. 2017;34:1173–83.
doi: 10.1007/s12325-017-0528-5
Esquinas C, Arance I, Pamplona J, Moraga A, Dorado JF, Angulo JC. Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS) with preattached scrotal port. Actas Urol Esp. 2018;42:473–82.
doi: 10.1016/j.acuro.2018.02.005
Esquinas C, Angulo JC. Effectiveness of adjustable transobturator male system (ATOMS) to treat male stress incontinence: a systematic review and meta-analysis. Adv Ther. 2019;36:426–41.
doi: 10.1007/s12325-018-0852-4
McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, et al. No surgical innovation without evaluation: the IDEAL recommendations. Lancet. 2009;374:1105–12.
doi: 10.1016/S0140-6736(09)61116-8
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
doi: 10.1097/01.sla.0000133083.54934.ae
Hermans B, Van der Aa F. Surgery for male stress incontinence: which technique and when? Eur Urol Focus. 2019;5:310–1.
doi: 10.1016/j.euf.2019.03.017
Angulo JC, Cruz F, Esquinas C, Arance I, Manso M, Rodríguez A, Pereira J, Ojea A, Carballo M, Rabassa M, Teyrouz A, Escribano G, Rodríguez E, Teba F, Celada G, Madurga B, Álvarez-Ossorio JL, Marcelino JP, Martins FE. Treatment of male stress urinary incontinence with the adjustable transobturator male system: outcomes of a multi-center Iberian study. Neurourol Urodyn. 2018;37:1458–66.
doi: 10.1002/nau.23474
Angulo JC, Virseda-Chamorro M, Arance I, Ruiz S, Ojea A, Carballo M, Rodríguez A, Pereira J, Teyrouz A, Rebassa M, Escribano G, Teba F, Celada G, Madurga B, Martins FE, Mendes PA, Cruz F. Long-term outcome of adjustable transobturator male system for stress urinary incontinence in the Iberian multicentre study. Neurourol Urodyn. 2020;39:1737–45.
doi: 10.1002/nau.24410
Angulo JC, Esquinas C, Arance I, Rodríguez A, Pereira J, Rabassa M, Teyrouz A, Teba F, Celada G, Marcelino JP, Martins FE, Manso M, Cruz F. Adjustable transobturator male system after failed surgical devices for male stress urinary incontinence: a feasibility study. Urol Int. 2018;101:106–13.
doi: 10.1159/000489316
Comiter CV, Dobberfuhl AD. The artificial urinary sphincter and male sling for postprostatectomy incontinence: which patient should get which procedure? Investig Clin Urol. 2016;57:3–13.
doi: 10.4111/icu.2016.57.1.3
Lavi A, Boone TB, Cohen M, Gross M. The patient beyond the sphincter-cognitive and functional considerations affecting the natural history of artificial urinary sphincters. Urology. 2020;137:14–8.
doi: 10.1016/j.urology.2019.11.031
Medendorp AR, Anger JT, Jin C, Amin KA, Hampson LA, Lee UJ, Suskind AM. The impact of frailty on artificial urinary sphincter placement and removal procedures. Urology. 2019;129:210–6.
doi: 10.1016/j.urology.2019.04.015
Grabbert M, Bauer RM, Hüsch T, Kretschmer A, Kirschner-Hermanns R, Anding R, Brehmer B, Naumann CM, Queissert F, Khoder WY, Gratzke C, Hofmann T, Haferkamp A, Huebner WA. Patient selection in surgical centers of expertise in the treatment of patients with moderate to severe male urinary stress incontinence. Urol Int. 2020;24:1–6.
Shakir NA, Fuchs JS, McKibben MJ, Viers BR, Pagliara TJ, Scott JM, Morey AF. Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success. Neurourol Urodyn. 2018;37:2632–7.
doi: 10.1002/nau.23703
Kim SP, Sarmast Z, Daignault S, Faerber GJ, McGuire EJ, Latini JM. 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;179:1912–6.
doi: 10.1016/j.juro.2008.01.048
Mühlstädt S, Angulo JC, Mohammed N, Schumann A, Fornara P. Complications of the urinary incontinence system ATOMS: description of risk factors and how to prevent these pitfalls. World J Urol. 2020;38:1795–803.
doi: 10.1007/s00345-019-02962-w
Friedl A, Mühlstädt S, Zachoval R, Giammò A, Kivaranovic D, Rom M, Fornara P, Brössner C. Long-term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study. BJU Int. 2017;119:785–92.
doi: 10.1111/bju.13684
Mock S, Dmochowski RR, Brown ET, Reynolds WS, Kaufman MR, Milam DF. The impact of urethral risk factors on transcorporeal artificial urinary sphincter erosion rates and device survival. J Urol. 2015;194:1692–6.
doi: 10.1016/j.juro.2015.06.088
Queissert F, Hüsch T, Kretschmer A, Anding R, Kirschner-Hermanns R, Pottek T, Olianas R, Friedl A, Homberg R, Pfitzenmaier J, Naumann CM, Nyarangi-Dix J, Hofmann T, Rose A, Schweiger J, Hübner W, Loertzer H, Bauer RM, Haferkamp A, Schrader AJ. Debates On Male Incontinence (DOMINO)-Project. High/low-volume center experience predicts outcome of AMS 800 in male stress incontinence: results of a large middle European multicenter case series. Neurourol Urodyn. 2020. https://doi.org/10.1002/nau.24444 .
doi: 10.1002/nau.24444
pubmed: 32567709
Grabbert M, Hüsch T, Kretschmer A, Kirschner-Hermanns R, Anding R, Rose A, Friedl A, Obaje A, Heidenreich A, Brehmer B, Naumann CM, Queissert F, Loertzer H, Pfitzenmaier J, Nyarangi-Dix J, Kurosch M, Olianas R, Homberg R, Abdunnur R, Schweiger J, Hofmann T, Wotzka C, Pottek T, Huebner W, Haferkamp A, Bauer RM. Comparison of adjustable male slings and artificial urinary sphincter in the treatment of male urinary incontinence: a retrospective analysis of patient selection and postoperative continence status. World J Urol. 2019;37:1415–20.
doi: 10.1007/s00345-018-2523-0
Kretschmer A, Hüsch T, Thomsen F, Kronlachner D, Obaje A, Anding R, Pottek T, Rose A, Olianas R, Friedl A, Hübner W, Homberg R, Pfitzenmaier J, Queissert F, Naumann CM, Wotzka C, Hofmann T, Seiler R, Haferkamp A, Bauer RM. Debates On Male Incontinence (DOMINO)-Project. Targeting moderate and severe male stress urinary incontinence with adjustable male slings and the perineal artificial urinary sphincter: focus on perioperative complications and device explantations. Int Neurourol J. 2017;21:109–15.
doi: 10.5213/inj.1632626.313
Angulo JC, Schönburg S, Giammò A, Abellán FJ, Arance I, Lora D. Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and Adjustable Continence Therapy (ProACT) for male stress incontinence. PLoS ONE. 2019;14(12):e0225762.
doi: 10.1371/journal.pone.0225762
Angulo JC, Ruiz S, Lozano M, Arance I, Virseda M, Lora D. Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and male Readjustment Mechanical External (REMEEX) system for post-prostatectomy incontinence. World J Urol. 2020. https://doi.org/10.1007/s00345-020-03300-1 .
doi: 10.1007/s00345-020-03300-1
pubmed: 32944804