Clinical Department, Universidad Europea de Madrid, Hospital Universitario de Getafe, Madrid, Spain.
Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany.
Neurourol Urodyn. 2021 Mar;40(3):897-909. doi: 10.1002/nau.24646. Epub 2021 Mar 1.
To evaluate treatment options after surgical revision of adjustable transobturator male system (ATOMS) and the results of further incontinence implantation.
A retrospective multicenter study evaluating patients with surgical revision of ATOMS in academic institutions. Causes and factors affecting revision-free interval were studied and also the frequency of device explant and placement of second ATOMS or artificial urinary sphincter (AUS) at surgeon discretion. Operative results, complications (Clavien-Dindo), and efficacy (postoperative pad-test, pad-count, patient satisfaction, and patient global impression of improvement [PGI-I scale]) of each treatment option were compared.
Seventy-eight out of 902 patients (8.65%) with ATOMS underwent surgical revision at 4.1 ± 2.4 years mean follow-up and 75 (8.3%) were explanted. The main causes for revision included persistence of incontinence (35.9%) and scrotal port erosion (34.6%). Independent risk factors of the shortened revision-free interval were previous anti-incontinence surgery (HR, 1.83; 95% CI, 1.06-3.16; p = 0.007) and port erosion (HR, 1.83; 95% CI, 1.06-3.16; p = 0.0027). Fifty-eight (6.4%) received a second implant: 31 repeated ATOMS and 27 AUS. Operative time was longer for AUS (p = .003). The visual analog scale of pain at hospital discharge (p = 0.837) and postoperative complications (p = 0.154) were equivalent. The predominant cuff size for AUS was 4.5 cm (59.3%). Mean follow-up after the second implant was 29.1 ± 25.8 months. Postoperative efficacy of secondary treatment results favored ATOMS based on pad-test (p = 0.016), pad-count (p = 0.029), patient satisfaction (p = 0.04), and PGI-I (p = 0.025).
ATOMS surgical revision due to different reasons generally leads to device explant. Rescue treatment is possible with ATOMS or AUS. No difference in postoperative complications was detected between secondary devices, but efficacy favors repeating ATOMS implantation.
评估可调经闭孔男性系统（ATOMS）手术后的治疗选择以及进一步治疗尿失禁的效果。
本研究为回顾性多中心研究，评估了学术机构中接受 ATOMS 手术翻修的患者。研究了无翻修间隔的原因和影响因素，以及根据医生的判断，设备取出的频率以及第二次 ATOMS 或人工尿道括约肌（AUS）的植入情况。比较了每种治疗选择的手术结果、并发症（Clavien-Dindo 分类）、疗效（术后尿垫试验、尿垫计数、患者满意度和患者总体改善印象[PGI-I 量表]）。
在 902 例 ATOMS 患者中，有 78 例（8.65%）在平均随访 4.1±2.4 年后接受了手术翻修，其中 75 例（8.3%）进行了设备取出。翻修的主要原因包括持续性尿失禁（35.9%）和阴囊端口侵蚀（34.6%）。缩短无翻修间隔的独立危险因素包括既往抗失禁手术（HR，1.83；95%CI，1.06-3.16；p=0.007）和端口侵蚀（HR，1.83；95%CI，1.06-3.16；p=0.0027）。58 例（6.4%）接受了第二次植入：31 例重复 ATOMS 和 27 例 AUS。AUS 的手术时间更长（p=0.003）。出院时的视觉模拟评分疼痛（p=0.837）和术后并发症（p=0.154）无差异。AUS 的主要袖套尺寸为 4.5cm（59.3%）。第二次植入后的平均随访时间为 29.1±25.8 个月。根据尿垫试验（p=0.016）、尿垫计数（p=0.029）、患者满意度（p=0.04）和 PGI-I（p=0.025），二次治疗的结果更有利于 ATOMS。
由于不同的原因，ATOMS 手术翻修通常会导致设备取出。可以使用 ATOMS 或 AUS 进行抢救治疗。两种辅助设备的术后并发症无差异，但疗效更倾向于重复 ATOMS 植入。
