Analyzing outcomes of the Adjustable Transobturator Male System (ATOMS) for post-prostatectomy incontinence and its relationship with overactive bladders and radiotherapy
Samuel Farag1, Joanie Pelletier1, Salima Ismail1, Le Mai Tu1.
1FMSS, Université de Sherbrooke, Sherbrooke, QC, Canada
Introduction: The Adjustable Transobturator Male System (ATOMS) has been a treatment option for post-prostatectomy incontinence (PPI) in Canada since 2014. We report our single center's device effectiveness and security. We also explore the effects of prior radiotherapy and of overactive bladder (OAB) on these outcomes.
Methods: A retrospective study was done on 91 patients who had ATOMS implanted at our center. To classify mild, moderate, and severe incontinence, preoperative incontinence severity was defined as <2 pads per day (PPD), 2–4 PPD, and >4 PPD regarding 24-hour pad-count and/or <200 g, 200–400 g, and >400 g regarding 24-hour pad-test (24h-PT). "Dry" meant having ≤1 PPD postoperatively. “Improved” or “very much improved” patients were defined as having a cut in PPD by ≥50% or ≥75%, respectively. “Satisfied” patients were defined as having “much better” and “very much better” Patient Global Impression of Improvement-Incontinence (PGI-I) results.
Results: A total of 65 patients were included (26 excluded due to followup <12 months). Mean patient age was 71 years and mean followup was 29.9 months (SE 1.8; [12–67]). Median preoperative PPD and 24h-PT were 4 (interquartile range [IQR] 6–3; [1–10]) and 358 g (IQR 607–256; [34–1592]), respectively. Median PPD at final followup was 1 (IQR 2–0; [0–5]; p<0.001). Fifty-six (86.2%) patients noted overall improvement, with 43 (76.7%) being "very much improved" and 42 (75.0%) being "dry." Fifty-seven (87.7%) patients were satisfied. Eight (12.3%) patients experienced complications of any Clavien-Dindo grade, of which four were grade III (one device migration, three explantations due to leakage). Patients having received prior radiotherapy (n=22, 33.8%) had lower improvement (73% vs. 93%, p=0.03) and “dry“ (45.5% vs. 74.4%, p=0.02) rates, yet had a higher number of adjustments (MED 3.5 vs. 2, p=0.01) and total instilled volume (MED 18.3 mL vs. 13 mL, p=0.01). No other statistically significant difference was found in this subgroup or in that of patients with OAB.
Conclusions: This study vouches for ATOMS as a safe and effective device to treat PPI. Also, radiotherapy seems to influence effectiveness, whereas OABs do not.
