{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T10:06:44Z","timestamp":1768990004152,"version":"3.49.0"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate treatment options after surgical revision of adjustable transobturator male system (ATOMS) and the results of further incontinence implantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>A retrospective multicenter study evaluating patients with surgical revision of ATOMS in academic institutions. Causes and factors affecting revision\u2010free interval were studied and also the frequency of device explant and placement of second ATOMS or artificial urinary sphincter (AUS) at surgeon discretion. Operative results, complications (Clavien\u2013Dindo), and efficacy (postoperative pad\u2010test, pad\u2010count, patient satisfaction, and patient global impression of improvement [PGI\u2010I scale]) of each treatment option were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010eight out of 902 patients (8.65%) with ATOMS underwent surgical revision at 4.1\u2009\u00b1\u20092.4 years mean follow\u2010up and 75 (8.3%) were explanted. The main causes for revision included persistence of incontinence (35.9%) and scrotal port erosion (34.6%). Independent risk factors of the shortened revision\u2010free interval were previous anti\u2010incontinence surgery (HR, 1.83; 95% CI, 1.06\u20133.16; <jats:italic>p<\/jats:italic>\u2009=\u20090.007) and port erosion (HR, 1.83; 95% CI,\u00a01.06\u20133.16; <jats:italic>p<\/jats:italic>\u2009=\u20090.0027). Fifty\u2010eight (6.4%) received a second implant: 31 repeated ATOMS and 27 AUS. Operative time was longer for AUS (<jats:italic>p<\/jats:italic>\u2009=\u2009.003). The visual analog scale\u00a0of pain at hospital discharge (<jats:italic>p<\/jats:italic>\u2009=\u20090.837) and postoperative complications (<jats:italic>p<\/jats:italic>\u2009=\u20090.154) were equivalent. The predominant cuff size for AUS was 4.5\u2009cm (59.3%). Mean follow\u2010up after the second implant was 29.1\u2009\u00b1\u200925.8 months. Postoperative efficacy of secondary treatment results favored ATOMS based on pad\u2010test (<jats:italic>p<\/jats:italic>\u2009=\u20090.016), pad\u2010count (<jats:italic>p<\/jats:italic>\u2009=\u20090.029), patient satisfaction (<jats:italic>p<\/jats:italic>\u2009=\u20090.04), and PGI\u2010I (<jats:italic>p<\/jats:italic>\u2009=\u20090.025).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ATOMS surgical revision due to different reasons generally leads to device explant. Rescue treatment is possible with ATOMS or AUS. No difference in postoperative complications was detected between secondary devices, but efficacy favors repeating ATOMS implantation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/nau.24646","type":"journal-article","created":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T11:55:37Z","timestamp":1614599737000},"page":"897-909","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Artificial urinary sphincter or a second adjustable transobturator male system\u00a0offer equivalent outcomes in patients whom required revision on the initial ATOMS device: An international multi\u2010institutional experience"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1735-8792","authenticated-orcid":false,"given":"Javier C.","family":"Angulo","sequence":"first","affiliation":[{"name":"Clinical Department Universidad Europea de Madrid, Hospital Universitario de Getafe  Madrid 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Fundaci\u00f3n Jim\u00e9nez D\u00edaz  Madrid Spain"}]},{"given":"Francisco E.","family":"Martins","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio de Lisboa Norte, Hospital Santa Mar\u00eda  Lisboa Portugal"}]},{"given":"Keith","family":"Rourke","sequence":"additional","affiliation":[{"name":"Department of Urology Alberta University  Edmonton Alberta Canada"}]},{"given":"Francisco","family":"Cruz","sequence":"additional","affiliation":[{"name":"Department of Urology Centro Hospitalar S\u00e3o Jo\u00e3o  Oporto 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