Alexander Friedl1, Sandra Mühlstädt2, Maximilian Rom3, Danijel Kivaranovic4, Nasreldin Mohammed2, Paolo Fornara2, Clemens Brössner5. 1. Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria. Electronic address: friedl.urologie@gmail.com. 2. Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin Luther University of Halle-Wittenberg, Halle/Saale, Germany. 3. Department of Urology, Medical University Vienna, Vienna, Austria. 4. Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University Vienna, Vienna, Austria. 5. Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria.
Abstract
OBJECTIVE: To identify risk factors for treatment failure of men with the adjustable transobturator male system (ATOMS) for treating stress urinary incontinence (SUI). PATIENTS AND METHODS: Sixty-two patients with SUI after prostate surgery were provided with an ATOMS. The self-defined criteria for treatment failure (implant removal [A], no improvement or ≥3 pads/24 hours [B], and no improvement or ≥150 mL urine loss/24 hours [C]) were compared to anamnestic, clinical, and time-specific parameters: age, Charlson comorbidity index (CCI), urine culture (UC), previous ineffective implants, body mass index, radiotherapy, renal function (serum creatinine), smoker status, urethral strictures, SUI severity, surgery time, time to and season at implantation, and port system application. RESULTS: After a median follow-up of 17.7 months, 9 ATOMS (15%) were removed due to infection (8) or dysfunction (1); 23% and 16% had treatment failure of criteria B and C. Dry rate/overall success rate was 61%/87%. Age alone was no risk factor but the CCI and a positive UC were univariate significant predictors of the criteria A, B, and C. Besides, previous devices and renal failure were significantly associated with implant removal (A) and SUI severity with criterion C. In multivariate analysis, previous devices (P = .0163), positive UC (P = .0190), and SUI severity (P = .0123) were the strongest predictors of A, B, and C, respectively. CONCLUSION: A poor CCI, preoperative positive UC, severe SUI, and previous implants lead to more treatment failure and removal. Age, body mass index, radiotherapy, urethral strictures, current smoking, time-specific parameters, seasonality, and port system application did not influence the outcome.
OBJECTIVE: To identify risk factors for treatment failure of men with the adjustable transobturator male system (ATOMS) for treating stress urinary incontinence (SUI). PATIENTS AND METHODS: Sixty-two patients with SUI after prostate surgery were provided with an ATOMS. The self-defined criteria for treatment failure (implant removal [A], no improvement or ≥3 pads/24 hours [B], and no improvement or ≥150 mL urine loss/24 hours [C]) were compared to anamnestic, clinical, and time-specific parameters: age, Charlson comorbidity index (CCI), urine culture (UC), previous ineffective implants, body mass index, radiotherapy, renal function (serum creatinine), smoker status, urethral strictures, SUI severity, surgery time, time to and season at implantation, and port system application. RESULTS: After a median follow-up of 17.7 months, 9 ATOMS (15%) were removed due to infection (8) or dysfunction (1); 23% and 16% had treatment failure of criteria B and C. Dry rate/overall success rate was 61%/87%. Age alone was no risk factor but the CCI and a positive UC were univariate significant predictors of the criteria A, B, and C. Besides, previous devices and renal failure were significantly associated with implant removal (A) and SUI severity with criterion C. In multivariate analysis, previous devices (P = .0163), positive UC (P = .0190), and SUI severity (P = .0123) were the strongest predictors of A, B, and C, respectively. CONCLUSION: A poor CCI, preoperative positive UC, severe SUI, and previous implants lead to more treatment failure and removal. Age, body mass index, radiotherapy, urethral strictures, current smoking, time-specific parameters, seasonality, and port system application did not influence the outcome.
Authors: Javier C Angulo; Sonia Ruiz; Martín Lozano; Ignacio Arance; Miguel Virseda; David Lora Journal: World J Urol Date: 2020-06-11 Impact factor: 4.226
Authors: Javier C Angulo; Ignacio Arance; Antonio Ojea; Manuel Carballo; Andrés Rodríguez; Javier Pereira; Miguel Rebassa; Antoine Teyrouz; Gregorio Escribano; Fernando Teba; Blanca Madurga; Francisco E Martins; Francisco Cruz Journal: World J Urol Date: 2019-01-16 Impact factor: 4.226
Authors: Javier C Angulo; Sandra Schönburg; Alessandro Giammò; Francisco J Abellán; Ignacio Arance; David Lora Journal: PLoS One Date: 2019-12-02 Impact factor: 3.240