PD37-11 MULTI-CENTERED ASSESSMENT OF CLINICAL OUTCOMES AND FACTORS ASSOCIATED WITH FAILURE OF THE ADJUSTABLE TRANSOBTURATOR MALE SYSTEM (ATOMS)

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy II (PD37)1 Apr 2020PD37-11 MULTI-CENTERED ASSESSMENT OF CLINICAL OUTCOMES AND FACTORS ASSOCIATED WITH FAILURE OF THE ADJUSTABLE TRANSOBTURATOR MALE SYSTEM (ATOMS) Elaine Redmond*, Genevieve Nadeau, Le-Mai Tu, Christopher Doiron, Stephen Steele, Dean Elterman, Jennifer Locke, Sender Herschorn, Conrad Maciejewski, Neil Dwyer, Lysanne Campeau, Kevin Carlson, and Keith Rourke Elaine Redmond*Elaine Redmond* More articles by this author , Genevieve NadeauGenevieve Nadeau More articles by this author , Le-Mai TuLe-Mai Tu More articles by this author , Christopher DoironChristopher Doiron More articles by this author , Stephen SteeleStephen Steele More articles by this author , Dean EltermanDean Elterman More articles by this author , Jennifer LockeJennifer Locke More articles by this author , Sender HerschornSender Herschorn More articles by this author , Conrad MaciejewskiConrad Maciejewski More articles by this author , Neil DwyerNeil Dwyer More articles by this author , Lysanne CampeauLysanne Campeau More articles by this author , Kevin CarlsonKevin Carlson More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000908.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The adjustable transobturator male system (ATOMS) is a trans-obturator device with a non-circumferential adjustable hydraulic cushion used to treat sphincteric incontinence after prostate cancer treatment. The aim of this multicentre study was to assess postoperative outcomes from the ATOMS device and to identify factors influencing failure to achieve continence. METHODS: Men who underwent insertion of ATOMS for the treatment post prostatectomy incontinence between September 2015 and August 2019 at 9 Canadian centres were reviewed. 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 90-day complications. Other patient demographics included age, obesity (BMI≥35), comorbidities, concurrent radiotherapy, prior incontinence surgery, previous urethral stenosis, type of prostatectomy and pads per day (ppd). RESULTS: 295 patients with a mean age of 69.9 years were analyzed. Pre-operatively mean pad use was 4.2 ppd (1-12), 32.5% of patients reported severe incontinence (≥5 pads/day), 34.2% had concurrent radiotherapy and 20.0% had failed previous incontinence surgery. Initial post-operative pad use was 1.4 ppd before cushion adjustment (p<0.0001) and 0.9 ppd following adjustments (p<0.0001). 71.2% (n=210) patients underwent adjustment a mean of 2.1 (0-9) times for a mean total volume of 12.0mL. Overall continence rate was 72.9% (n=215) at a mean follow-up of 19.7 months. 89.2% (n=263) of patients experienced >50% improvement, 84.4% (n=249) of patients were satisfied with the results of surgery. 8.1% (n=24) required device explantation. On multivariate Cox regression analysis, concurrent radiotherapy (HR 2.5, p<0.0001), diabetes (HR 2.2, p=0.006) and increased pre-operative pad usage (HR 1.1, p=0.03) were associated with failure to achieve continence, while patient age (p=0.51), obesity (p=0.08), prior urethral stenosis (p=0.66) and prior incontinence surgery (p=0.17) were not. Radiation therapy was also associated with device explantation (HR 3.1, p=0.007). CONCLUSIONS: In the largest cohort study to date, ATOMS is a safe and efficacious device for the treatment of a broad spectrum of patients with post prostatectomy incontinence. Our study found a durable response on continued follow-up, with high rates of continence, improvement and patient satisfaction. Patients with prior radiation, increased pre-operative pad use and diabetes are less likely to achieve continence. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e732-e732 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elaine Redmond* More articles by this author Genevieve Nadeau More articles by this author Le-Mai Tu More articles by this author Christopher Doiron More articles by this author Stephen Steele More articles by this author Dean Elterman More articles by this author Jennifer Locke More articles by this author Sender Herschorn More articles by this author Conrad Maciejewski More articles by this author Neil Dwyer More articles by this author Lysanne Campeau More articles by this author Kevin Carlson More articles by this author Keith Rourke More articles by this author Expand All Advertisement PDF downloadLoading ...