Javier C. Angulo, Alessandro Giammò, Fabian Queissert, Sandra Schönburg, Carmen González-Enguita, Andreas Gonsior, Antonio Romero, Francisco E. Martins, Tiago Antunes-Lopes, Raquel González, Juliusz Szczesniewski, Carlos Téllez, Francisco Cruz, Keith F. Rourke
{"title":"可调节经尿道男性系统（ATOMS）在放射治疗患者中的有效性降低：倾向得分匹配分析","authors":"Javier C. Angulo, Alessandro Giammò, Fabian Queissert, Sandra Schönburg, Carmen González-Enguita, Andreas Gonsior, Antonio Romero, Francisco E. Martins, Tiago Antunes-Lopes, Raquel González, Juliusz Szczesniewski, Carlos Téllez, Francisco Cruz, Keith F. Rourke","doi":"10.1002/bco2.329","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>This study aimed to compare the effectiveness and safety of the adjustable trans-obturator male system (ATOMS®) to treat post-prostatectomy incontinence (PPI) in radiated patients compared with non-radiated patients, using propensity score-matching analysis to enhance the validity of the comparison.</p>\n </section>\n \n <section>\n \n <h3> Patients and methods</h3>\n \n <p>Consecutive men with PPI treated with silicone-covered scrotal port ATOMS (A.M.I., Feldkirch, Austria) in nine different institutions between 2016 and 2022 were included. Preoperative assessment evaluated 24-h pad usage, urethroscopy and urodynamics, if indicated. Propensity score-matching analysis was based on age, length of follow-up, previous PPI treatment, previous bladder neck stricture, androgen deprivation and pad usage. The primary endpoint was dry rate, defined as no pads post-operatively with a security pad allowed. The secondary endpoints were complications, device removal and self-perceived satisfaction with the Patient Global Impression of Improvement (PGI-I) scale.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of the 710 included patients, 342 were matched, and the study groups were balanced for the baseline matched variables. The mean baseline 24-h pad was 4.8 in both groups (<i>p</i> = 0.48). The mean follow-up was 27.5 ± 18.6 months, which was also equivalent between groups (<i>p</i> = 0.36). The primary outcome was achieved in 73 (42.7%) radiated patients and in 115 (67.3%) non-radiated patients (<i>p</i> < 0.0001). The mean pad count at the last follow-up was 1.5 and 0.8, respectively (<i>p</i> < 0.0001). There was no significant difference in complications (<i>p</i> = 0.94), but surgical revision and device explant rates were higher (<i>p</i> = 0.03 and <i>p</i> = 0.01, respectively), and the proportion of patients highly satisfied (PGI-I = 1) was lower in the radiated group (<i>p</i> = 0.01). At sensitivity analysis, the study was found to be reasonably robust to hidden bias.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>ATOMS implantation significantly outperformed in patients without adjuvant radiation over radiated patients.</p>\n </section>\n </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 4","pages":"506-514"},"PeriodicalIF":1.6000,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.329","citationCount":"0","resultStr":"{\"title\":\"The effectiveness of adjustable trans-obturator male system (ATOMS) in radiated patients is reduced: A propensity score-matched analysis\",\"authors\":\"Javier C. Angulo, Alessandro Giammò, Fabian Queissert, Sandra Schönburg, Carmen González-Enguita, Andreas Gonsior, Antonio Romero, Francisco E. Martins, Tiago Antunes-Lopes, Raquel González, Juliusz Szczesniewski, Carlos Téllez, Francisco Cruz, Keith F. Rourke\",\"doi\":\"10.1002/bco2.329\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>This study aimed to compare the effectiveness and safety of the adjustable trans-obturator male system (ATOMS®) to treat post-prostatectomy incontinence (PPI) in radiated patients compared with non-radiated patients, using propensity score-matching analysis to enhance the validity of the comparison.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Patients and methods</h3>\\n \\n <p>Consecutive men with PPI treated with silicone-covered scrotal port ATOMS (A.M.I., Feldkirch, Austria) in nine different institutions between 2016 and 2022 were included. Preoperative assessment evaluated 24-h pad usage, urethroscopy and urodynamics, if indicated. Propensity score-matching analysis was based on age, length of follow-up, previous PPI treatment, previous bladder neck stricture, androgen deprivation and pad usage. The primary endpoint was dry rate, defined as no pads post-operatively with a security pad allowed. The secondary endpoints were complications, device removal and self-perceived satisfaction with the Patient Global Impression of Improvement (PGI-I) scale.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Of the 710 included patients, 342 were matched, and the study groups were balanced for the baseline matched variables. The mean baseline 24-h pad was 4.8 in both groups (<i>p</i> = 0.48). The mean follow-up was 27.5 ± 18.6 months, which was also equivalent between groups (<i>p</i> = 0.36). The primary outcome was achieved in 73 (42.7%) radiated patients and in 115 (67.3%) non-radiated patients (<i>p</i> < 0.0001). The mean pad count at the last follow-up was 1.5 and 0.8, respectively (<i>p</i> < 0.0001). There was no significant difference in complications (<i>p</i> = 0.94), but surgical revision and device explant rates were higher (<i>p</i> = 0.03 and <i>p</i> = 0.01, respectively), and the proportion of patients highly satisfied (PGI-I = 1) was lower in the radiated group (<i>p</i> = 0.01). 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The effectiveness of adjustable trans-obturator male system (ATOMS) in radiated patients is reduced: A propensity score-matched analysis
Objectives
This study aimed to compare the effectiveness and safety of the adjustable trans-obturator male system (ATOMS®) to treat post-prostatectomy incontinence (PPI) in radiated patients compared with non-radiated patients, using propensity score-matching analysis to enhance the validity of the comparison.
Patients and methods
Consecutive men with PPI treated with silicone-covered scrotal port ATOMS (A.M.I., Feldkirch, Austria) in nine different institutions between 2016 and 2022 were included. Preoperative assessment evaluated 24-h pad usage, urethroscopy and urodynamics, if indicated. Propensity score-matching analysis was based on age, length of follow-up, previous PPI treatment, previous bladder neck stricture, androgen deprivation and pad usage. The primary endpoint was dry rate, defined as no pads post-operatively with a security pad allowed. The secondary endpoints were complications, device removal and self-perceived satisfaction with the Patient Global Impression of Improvement (PGI-I) scale.
Results
Of the 710 included patients, 342 were matched, and the study groups were balanced for the baseline matched variables. The mean baseline 24-h pad was 4.8 in both groups (p = 0.48). The mean follow-up was 27.5 ± 18.6 months, which was also equivalent between groups (p = 0.36). The primary outcome was achieved in 73 (42.7%) radiated patients and in 115 (67.3%) non-radiated patients (p < 0.0001). The mean pad count at the last follow-up was 1.5 and 0.8, respectively (p < 0.0001). There was no significant difference in complications (p = 0.94), but surgical revision and device explant rates were higher (p = 0.03 and p = 0.01, respectively), and the proportion of patients highly satisfied (PGI-I = 1) was lower in the radiated group (p = 0.01). At sensitivity analysis, the study was found to be reasonably robust to hidden bias.
Conclusion
ATOMS implantation significantly outperformed in patients without adjuvant radiation over radiated patients.
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