Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male Sys
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ORIGINAL RESEARCH
Outcomes of a Series of Patients with PostProstatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter Cristina Esquinas . Sonia Ruiz . Elena de Sancha . Mo´nica Vazquez . Juan F. Dorado . Miguel Virseda . Ignacio Arance . Javier C. Angulo
Received: October 10, 2020 / Accepted: November 4, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: A prospective evaluation of outcomes in a series of patients with post-prostatectomy incontinence (PPI) treated with two different devices is presented. Methods: Consecutive patients with PPI underwent interventions with an adjustable transobturator male system (ATOMS) or artificial urinary sphincter (AUS). Decisions were based on patient preference after physician counselling. Patient characteristics and operative and postoperative parameters including dryness, satisfaction, complications, revision and device durability were evaluated. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12325020-01563-z) contains supplementary material, which is available to authorized users. C. Esquinas S. Ruiz M. Virseda I. Arance J. C. Angulo (&) Department of Urology, Hospital Universitario de Getafe, Getafe, Madrid, Spain e-mail: [email protected]; [email protected] E. de Sancha M. Vazquez I. Arance J. C. Angulo Department of Medical Clinic, Faculty of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain J. F. Dorado PeRTICA Ana´lisis Estadı´sticos S.L., Getafe, Madrid, Spain
Results: One hundred twenty-nine patients were included: 102 (79.1%) received ATOMS and 27 (20.9%) AUS. Mean follow-up was 34.9 ± 15.9 months. No difference was observed between patient age (p = 0.56), ASA score (p = 0.13), Charlson index (p = 0.57) and radiation (p = 0.3). BMI was higher for AUS (27.1 vs. 29.7; p = 0.003) and also baseline incontinence severity (7.9% mild, 44.1% moderate and 48% severe for ATOMS vs. 11.1% moderate and 88.9% severe for AUS; p = 0.0007). Differential pad test was higher for AUS (- 470 vs. - 1000 ml; p \ 0.0001) and so was ICIQ-SF (15.62 vs. 18.3; p\ 0.001), but total dryness (76.5 vs. 66.7%; p = 0.33), social continence (90.2 vs. 85.2%; p = 0.49) and satisfaction (92.2 vs. 88.9%; p = 0.69) were equivalent. The postoperative complication rate was similar (22.6 vs. 29.6%; p = 0.4). The surgical revision rate was higher for AUS (6.9 vs. 22.2%; p = 0.029) and also the explant rate but did not reach statistical significance (4.9 vs. 14.8%; p = 0.09). Time to explant was shorter for AUS (log-rank p = 0.021). Regression analysis revealed radiation (p = 0.003) and incontinence severity (p = 0.029) predict total dryness, while complications (p \ 0.005) and type of device (p = 0.039) independently predict surgical revision. Conclusions: Both ATOMS and AUS are effective devices. Pad test change for AUS exceeds that of ATOMS. The revision rate is higher for AUS, and durability is superior for ATOMS. The
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