Novel device improves post-prostatectomy incontinence

Published on December 3, 2012 at 9:15 AM · No Comments

By , medwireNews Reporter

Researchers have developed a novel device that improves stress urinary incontinence (SUI) in men who have undergone prostatectomy, report researchers.

In a cohort of 99 men, the adjustable transobturator male system (ATOMS) device had an overall success rate of 92% over a mean follow-up time of 17.8 months.

In recent years, various minimally invasive sling systems have been investigated as treatment options for post-prostatectomy incontinence, with success rates similar to those found with the artificial urinary sphincter (AUS), which is currently considered the "gold standard" solution to SUI but can be associated with complications.

However, one of the drawbacks of using slings is the lack of ability to make postoperative adjustment, which can turn the procedure into one of trial and error, explain Gunter Primus (Medical University, Graz, Austria) and colleagues.

"The basic idea behind this device is a self-anchoring adjustable system to support the bulbar urethra using the transobturator approach," says the team. "Unlike the AUS, which compresses the urethra circumferentially thereby interfering with venous blood flow predisposing to urethral atrophy and erosion, the ATOMS device compresses only the dorsal aspects of the bulbar urethra, leaving the ventral and lateral blood flow intact."

As reported in BJU International, the mean age of the patients was 70.4 years and the most common reason for needing treatment was incontinence after radical laparoscopic, perineal, or retropubic prostatectomy (92.9%).

After removal of the transurethral catheter 24 hours after surgery, temporary urinary retention occurred in two patients (2%), which resolved after 4 mL filling solution was removed and the patients were catheterized for a further 48 hours.

Transient perineal/scrotal dysesthesia or pain was reported by 68 (68.7%) of 99 patients and resolved spontaneously with the use of nonopioid analgesics for 3-4 hours. Four (4%) cases of wound infection occurred at the site of the titanium port, leading to complete explantation of the device and subsequent reimplantation after 3 months.

No urethral or bladder injuries related to the device or erosions occurred.

The mean number of adjustments of the device that were needed to reach the desired effects (dryness, improvement and/or patient satisfaction) was 3.8.

At the end of follow-up, the overall mean success rate was 92%. The mean number of pads used decreased from 7.1 to 1.3, and 63% of patients were considered dry, while 29% were considered improved.

"These data suggest that the ability to make adjustment at any time in male sling systems should be considered a prerequisite when managing men with SUI," conclude Primus et al.

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