The objective of this study was to report outcome measures with third-generation pre-attached scrotal port adjustable transobturator male system (ATOMS) for male stress urinary incontinence (SUI) after radical prostatectomy.
A prospective open study was conducted on consecutive patients. Evaluation included cough test, urethroscopy, filling and voiding cystometry, 24-h pad count and pad test, patient-reported outcomes (ICIQ-SF, IIQ-7, PGI, GRA, and VAS), complications according to the Clavien-Dindo system, operative results, number of adjustments, and filling of the system.
Thirty-four patients with median pad test 510 (170-1225) ml were operated on. Preoperative SUI was mild (5.9%), moderate (17.6%), and severe (76.5%). At median 18.5 (12-26) months follow-up distribution of SUI was none (85.3%), mild (8.8%), and moderate (5.9%). Median intraoperative filling was 14 (8-17) ml, number of adjustments 1 (0-5), and total filling 17.5 (11-33.5) ml. At 3 months, median ICIQ-SF (p = 0.0001) and IIQ-7 (p < 0.0001) decreased. At 12 months, 24-h pad count and pad test decreased (both p < 0.0001), residual volume slightly increased (p = 0.018), PGI-I was 1 (1-3), GRA 6 (3-6), and 97% were satisfied with treatment. Continence (p = 0.016) and satisfaction (p = 0.09) were worse in irradiated patients. Median operative time was 67 (35-120) min, hospital stay 1 (1-3) days, and VAS for pain on postoperative day 1 was 0 (0-2). Complications presented in 14.7% (8.8% grade I and 5.9% grade III).
Treatment of severe male SUI after radical prostatectomy with pre-attached scrotal port ATOMS is safe and very effective in the short term. A positive cough test before implant and intraoperative overfilling of the system may optimize patient selection and results.
Advances in therapy. 2017 Apr 12 [Epub ahead of print]
Javier C Angulo, Ignacio Arance, Cristina Esquinas, Juan F Dorado, João P Marcelino, Francisco E Martins
Servicio de Urología, Departamento Clínico, Facultad de Ciencias Biomédicas, Hospital Universitario de Getafe, Universidad Europea de Madrid, Laureate Universities, Madrid, Spain. ., Servicio de Urología, Departamento Clínico, Facultad de Ciencias Biomédicas, Hospital Universitario de Getafe, Universidad Europea de Madrid, Laureate Universities, Madrid, Spain., Pertica S.L., Getafe, Madrid, Spain., Departamento de Urología, Hospital de Santa María, Universidad de Lisboa, Lisbon, Portugal.