title: Risk Factors for Treatment Failure With the Adjustable Transobturator Male System Incontinence Device: Who Will Succeed, Who Will Fail? Results of a Multicenter Study.
abstract: OBJECTIVE
  To identify risk factors for treatment failure of men with the adjustable transobturator male system (ATOMS) for treating stress urinary incontinence (SUI).
  
  
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria. Electronic address: friedl.urologie@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Friedl
authors.affiliation: Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin Luther University of Halle-Wittenberg, Halle/Saale, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Mühlstädt
authors.affiliation: Department of Urology, Medical University Vienna, Vienna, Austria.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Rom
authors.affiliation: Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University Vienna, Vienna, Austria.
authors.forename: Danijel
authors.initials: D
authors.lastname: Kivaranovic
authors.affiliation: Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin Luther University of Halle-Wittenberg, Halle/Saale, Germany.
authors.forename: Nasreldin
authors.initials: N
authors.lastname: Mohammed
authors.affiliation: Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin Luther University of Halle-Wittenberg, Halle/Saale, Germany.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fornara
authors.affiliation: Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria.
authors.forename: Clemens
authors.initials: C
authors.lastname: Brössner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods