title: Outcome Measures of Adjustable Transobturator Male System with Pre-attached Scrotal Port for Male Stress Urinary Incontinence After Radical Prostatectomy: A Prospective Study.
abstract: The objective of this study was to report outcome measures with third-generation pre-attached scrotal port adjustable transobturator male system (ATOMS) for male stress urinary incontinence (SUI) after radical prostatectomy.
  
  
  
  A prospective open study was conducted on consecutive patients. Evaluation included cough test, urethroscopy, filling and voiding cystometry, 24-h pad count and pad test, patient-reported outcomes (ICIQ-SF, IIQ-7, PGI, GRA, and VAS), complications according to the Clavien-Dindo system, operative results, number of adjustments, and filling of the system.
  
  
  
  Thirty-four patients with median pad test 510 (170-1225) ml were operated on. Preoperative SUI was mild (5.9%), moderate (17.6%), and severe (76.5%). At median 18.5 (12-26) months follow-up distribution of SUI was none (85.3%), mild (8.8%), and moderate (5.9%). Median intraoperative filling was 14 (8-17) ml, number of adjustments 1 (0-5), and total filling 17.5 (11-33.5) ml. At 3 months, median ICIQ-SF (p = 0.0001) and IIQ-7 (p < 0.0001) decreased. At 12 months, 24-h pad count and pad test decreased (both p < 0.0001), residual volume slightly increased (p = 0.018), PGI-I was 1 (1-3), GRA 6 (3-6), and 97% were satisfied with treatment. Continence (p = 0.016) and satisfaction (p = 0.09) were worse in irradiated patients. Median operative time was 67 (35-120) min, hospital stay 1 (1-3) days, and VAS for pain on postoperative day 1 was 0 (0-2). Complications presented in 14.7% (8.8% grade I and 5.9% grade III).
  
  
  
  Treatment of severe male SUI after radical prostatectomy with pre-attached scrotal port ATOMS is safe and very effective in the short term. A positive cough test before implant and intraoperative overfilling of the system may optimize patient selection and results.
authors.affiliation: Servicio de Urología, Departamento Clínico, Facultad de Ciencias Biomédicas, Hospital Universitario de Getafe, Universidad Europea de Madrid, Laureate Universities, Madrid, Spain. jangulo@futurnet.es.
authors.forename: Javier C
authors.initials: JC
authors.lastname: Angulo
authors.affiliation: Servicio de Urología, Departamento Clínico, Facultad de Ciencias Biomédicas, Hospital Universitario de Getafe, Universidad Europea de Madrid, Laureate Universities, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Arance
authors.affiliation: Servicio de Urología, Departamento Clínico, Facultad de Ciencias Biomédicas, Hospital Universitario de Getafe, Universidad Europea de Madrid, Laureate Universities, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Esquinas
authors.affiliation: Pertica S.L., Getafe, Madrid, Spain.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Dorado
authors.affiliation: Departamento de Urología, Hospital de Santa María, Universidad de Lisboa, Lisbon, Portugal.
authors.forename: João P
authors.initials: JP
authors.lastname: Marcelino
authors.affiliation: Departamento de Urología, Hospital de Santa María, Universidad de Lisboa, Lisbon, Portugal.
authors.forename: Francisco E
authors.initials: FE
authors.lastname: Martins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011474:Prosthesis Design; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
keywords: Adjustability; Adjustable transobturator male system (ATOMS); Male incontinence; Radical prostatectomy; Sphincter cushion; Urology