Multicentered Assessment of Clinical Outcomes and Factors Associated With Failure of the Adjustable TransObturator Male System (ATOMS).
Urology
; 148: 280-286, 2021 02.
Article
en En
| MEDLINE
| ID: mdl-33181122
ABSTRACT
OBJECTIVE:
To assess postoperative outcomes from the Adjustable TransObturator Male System (ATOMS) and identify factors influencing failure to achieve continence. PATIENTS ANDMETHODS:
A multicentered analysis was performed on all patients treated for postprostatectomy incontinence using the third-generation ATOMS at 9 Canadian tertiary referral centers. The primary outcome was continence (defined as requiring ≤1 pad postoperatively for patients requiring ≥2 pads preoperatively and 0 pads for those requiring 1 pad preoperatively). Secondary outcomes included improvement (>50% change in pad use), patient satisfaction, explantation, and postoperative complications.RESULTS:
Two hundred and eighty nine patients with a mean age of 68.9 years were analyzed. Pre-operatively mean pad per day use was 4.2 (1-12), 31.5% of patients reported severe incontinence (≥5 pads/day), 33.9% had concurrent radiotherapy and 19.4% had failed previous incontinence surgery. Overall continence rate was 73.3% (nâ¯=â¯212) at a mean follow-up of 19.6 months. More than eighty nine percent (89.3%) (nâ¯=â¯258) of patients experienced >50% improvement, 84.4% (nâ¯=â¯244) of patients were satisfied with the results of surgery. More than seven percent (7.9%) (nâ¯=â¯23) required device explantation. On multivariate Cox regression analysis, concurrent radiotherapy (hazard ratio [H.R.] 2.3, P < .001), diabetes (H.R. 2.2, Pâ¯=â¯.007) and increased pre-operative pad usage (H.R. 1.1, Pâ¯=â¯.02) were each associated with failure to achieve continence, while patient age (Pâ¯=â¯.60), obesity (Pâ¯=â¯.08), prior urethral stenosis (Pâ¯=â¯.56), and prior incontinence surgery (Pâ¯=â¯.13) were not. Radiation therapy was also associated with device explantation (H.R. 2.7, Pâ¯=â¯.02).CONCLUSION:
ATOMS is a safe and efficacious for treatment of postprostatectomy incontinence. However, patients with prior radiation, increased pre-operative pad use, or diabetes are less likely to achieve continence.
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Complicaciones Posoperatorias
/
Prostatectomía
/
Incontinencia Urinaria
/
Falla de Prótesis
/
Cabestrillo Suburetral
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
Urology
Año:
2021
Tipo del documento:
Article