The effectiveness of adjustable trans-obturator male system (ATOMS) in radiated patients is reduced: A propensity score-matched analysis.

Autor: Angulo JC; Clinical Department, Faculty of Biomedical Science Universidad Europea Madrid Spain.; Department of Urology Hospital Universitario de Getafe Madrid Spain., Giammò A; Department of Neuro-Urology, CTO/Spinal Cord Unit AOU Città della Salute e della Scienza di Torino Turin Italy., Queissert F; Department of Urology and Pediatric Urology University Hospital Muenster Münster Germany., Schönburg S; Department of Urology and Kidney Transplantation Martin Luther University Halle (Saale) Germany., González-Enguita C; Department of Urology Hospital Fundación Jiménez Díaz Madrid Spain., Gonsior A; Klinik und Poliklinik für Urologie University of Leipzig Leipzig Germany., Romero A; Department of Urology Hospital Universitario Morales Meseguer Murcia Spain., Martins FE; Department of Urology Centro Hospitalar Universitário de Lisboa Norte, Hospital Santa María Lisbon Portugal., Antunes-Lopes T; Department of Urology Centro Hospitalar São João Porto Portugal.; Faculty of Medicine of Porto I3S Institute Porto Portugal., González R; Department of Urology Hospital Fundación Jiménez Díaz Madrid Spain., Szczesniewski J; Department of Urology Hospital Universitario de Getafe Madrid Spain., Téllez C; Clinical Department, Faculty of Biomedical Science Universidad Europea Madrid Spain.; Department of Urology Hospital Universitario de Getafe Madrid Spain., Cruz F; Department of Urology Centro Hospitalar São João Porto Portugal.; Faculty of Medicine of Porto I3S Institute Porto Portugal., Rourke KF; Department of Urology Alberta University, Hospital Edmonton Edmonton Alberta Canada.
Jazyk: angličtina
Zdroj: BJUI compass [BJUI Compass] 2024 Feb 11; Vol. 5 (4), pp. 506-514. Date of Electronic Publication: 2024 Feb 11 (Print Publication: 2024).
DOI: 10.1002/bco2.329
Abstrakt: Objectives: This study aimed to compare the effectiveness and safety of the adjustable trans-obturator male system (ATOMS®) to treat post-prostatectomy incontinence (PPI) in radiated patients compared with non-radiated patients, using propensity score-matching analysis to enhance the validity of the comparison.
Patients and Methods: Consecutive men with PPI treated with silicone-covered scrotal port ATOMS (A.M.I., Feldkirch, Austria) in nine different institutions between 2016 and 2022 were included. Preoperative assessment evaluated 24-h pad usage, urethroscopy and urodynamics, if indicated. Propensity score-matching analysis was based on age, length of follow-up, previous PPI treatment, previous bladder neck stricture, androgen deprivation and pad usage. The primary endpoint was dry rate, defined as no pads post-operatively with a security pad allowed. The secondary endpoints were complications, device removal and self-perceived satisfaction with the Patient Global Impression of Improvement (PGI-I) scale.
Results: Of the 710 included patients, 342 were matched, and the study groups were balanced for the baseline matched variables. The mean baseline 24-h pad was 4.8 in both groups ( p  = 0.48). The mean follow-up was 27.5 ± 18.6 months, which was also equivalent between groups ( p  = 0.36). The primary outcome was achieved in 73 (42.7%) radiated patients and in 115 (67.3%) non-radiated patients ( p  < 0.0001). The mean pad count at the last follow-up was 1.5 and 0.8, respectively ( p  < 0.0001). There was no significant difference in complications ( p  = 0.94), but surgical revision and device explant rates were higher ( p  = 0.03 and p  = 0.01, respectively), and the proportion of patients highly satisfied (PGI-I = 1) was lower in the radiated group ( p  = 0.01). At sensitivity analysis, the study was found to be reasonably robust to hidden bias.
Conclusion: ATOMS implantation significantly outperformed in patients without adjuvant radiation over radiated patients.
Competing Interests: The authors declare no conflict of interest associated with the publication of this manuscript.
(© 2024 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.)
Databáze: MEDLINE
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