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. 2021 Jan;38(1):678-690.
doi: 10.1007/s12325-020-01563-z. Epub 2020 Nov 23.

Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter

Cristina Esquinas  1 , Sonia Ruiz  1 , Elena de Sancha  2 , Mónica Vazquez  2 , Juan F Dorado  3 , Miguel Virseda  1 , Ignacio Arance  1   2 , Javier C Angulo  4   5
Affiliations

Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter

Cristina Esquinas et al. Adv Ther. 2021 Jan.

Abstract

Introduction: A prospective evaluation of outcomes in a series of patients with post-prostatectomy incontinence (PPI) treated with two different devices is presented.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Adjustable transobturator male system; Artificial urinary sphincter; Effectiveness; Post-prostatectomy incontinence; Safety; Urology.

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Figures

Fig. 1
Fig. 1
Distribution of baseline ICIQ-SF
Fig. 2
Fig. 2
Proportion of dryness (zero pads or one pad with less than 10ml), social continence (1–2 pads/day), satisfaction, complications, surgical revision and explant with ATOMS and AUS
Fig. 3
Fig. 3
Differences in variation in 24-hour pad-test (last follow-up minus baseline)
Fig. 4
Fig. 4
Kaplan-Meier analysis of the explantation-free interval
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