Abstract
(1) Background: This study examined outcomes of second-line ATOMS implantation after failure of the fixed male sling (FMS) AdVance/AdVance XP. (2) Methods: A retrospective multicenter cohort analysis was carried out in men implanted with an ATOMS between 2011 and 2020 after failure of an AdVance/AdVance XP. Success was assessed on the basis of objective (dryness, 0–1 pad/24 h or >20 g/24 h pad test) and subjective results (PGI-I). We performed the Wilcoxon rank sum test, Fisher’s exact test, logistic regression, and multivariate analysis. (3) Results: The study included 88 patients from 9 centers with a mean age of 71.3 years. No Clavien–Dindo > II complications occurred within the first 3 months after ATOMS implantation. A total of 10 cases (9%) required revision in the ensuing clinical course. After a mean follow-up of 42.5 months, 76.1% achieved social continence, and 56.8% used no pads at all. Mean urine leakage/24 h dropped from 422 g (3.9 pads) to 38 g (0.69 pads) and the mean ICIQ-SF decreased from 16.25 to 5.3 (p < 0.0001). PROMs (patient-reported outcome measures) showed improvement in 98.9% of cases, and 63.6% gave a “very much better” PGI-I rating. Multivariate analysis identified a lower probability of achieving maximum satisfaction for the following factors: the AdVance XP as first-line therapy (OR 0.35), a lower ICIQ-SF question 1 (OR 0.26), status post-irradiation (OR 0.14), and more severe pain prior to ATOMS implantation (OR 0.51). (4) Conclusions: Implantation of an ATOMS is an effective and safe second-line treatment option for recurrent urinary incontinence after implantation of an AdVance/AdVance XP sling. High patient satisfaction was demonstrated in a long-term follow-up.
Highlights
Various surgical concepts are available for treating stress urinary incontinence (SUI)after radical prostatectomy
We identify risk factors for poorer outcome and propose a nomogram to facilitate the indication of ATOMS as a second-line treatment
A total of 88 patients intervened with ATOMS between 2011 and 2020 in 9 academic institutions were included in the study
Summary
Various surgical concepts are available for treating stress urinary incontinence (SUI)after radical prostatectomy. Various surgical concepts are available for treating stress urinary incontinence (SUI). The guidelines of the International Continence Society (ICS) still recommend as preferred treatment the artificial urinary sphincter (AUS). Fixed male slings (fMS) are mentioned as alternatives for patients with only mild to moderate SUI [1]. The. AdVance/AdVance XP (Boston Scientific, Marlborough, MA, USA) are the most commonly implanted fMS and are used in cases with a mobile bulbar urethra and intact urethral sphincter with coaptation zone >1 cm. If properly applied and correctly indicated, its retrourethral placement leads to dorsal stabilization of bulbar urethra and bulging and repositioning of the membranous urethra with consecutive improvement of functional length [2]. Cure rates for fMS range between 8.3% and 87%, depending on the definition of the success parameter “cured” and the severity of preexisting incontinence [3,4].
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