Adjustable Transobturator Male System after Failed Surgical Devices for Male Stress Urinary Incontinence: A Feasibility Study

作者：Angulo Javier C^*; Esquinas Cristina; Arance Ignacio; Rodriguez Andres; Pereira Javier; Rabassa Miguel; Teyrouz Antoine; Teba Fernando; Celada Guillermo; Marcelino Joao P; Martins Francisco E; Manso Margarida; Cruz Francisco

来源：Urologia Internationalis, 2018, 101(1): 106-113.

DOI：10.1159/000489316

• Stress urinary incontinence
• Adjustable transobturator male system
• Artificial urinary sphincter
• Male sling
• Rescue surgery
• Fragile urethra

Objectives: Feasibility study to evaluate the efficacy and safety of Adjustable Transobturator Male System (ATOMS) after failed surgical devices for male stress urinary incontinence (SUI). Materials and Methods: Thirty patients were implanted with ATOMS after they were implanted with surgical device/s previously. SUI severity was evaluated as dryness (0-1 pad/day), mild (2 pads/day), moderate (3-5 pads/day), or severe (>= 6 pads/day). Change in pad-test and pad-count after adjustment, operative parameters, patient satisfaction, and number and grade of complications were investigated. Results: Previous failed treatment methods were artificial urinary sphincter (AUS; n = 19), Advance (n = 10), and Virtue (n = 1). Six cases had multiple previous treatments. Preoperative SUI was mild 6 (20%), moderate 11 (36.7%), and severe 13 (43.3%). Median pad-test decreased from 435 mL baseline to 10 mL after adjustment and pad-count from 4 to 0. Dry-rate was 76.7 and 83.3% declared satisfied. Postoperative SUI distribution was mild in 3 (10%) and moderate in 4 (13.3%). No patient had urinary retention after catheter removal. Complications presented in 4 (13.3%; 3 grade-I, 1 grade-II). After a median of 24 months follow-up, no system experienced infection or urethral erosion and 1 (3.3%) was removed for inefficacy. Conclusion: Based on short-term efficacy and patient satisfaction, ATOMS can be a realistic alternative for male SUI after other failed systems, including AUS. The absence of urethral erosion and limited infective problems makes this alternative attractive for cases with previous failed treatments.

• 出版日期2018