{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:05:10Z","timestamp":1770336310264,"version":"3.49.0"},"reference-count":56,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T00:00:00Z","timestamp":1689552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Presurgy (Las Rozas, Madrid)"},{"name":"A.M.I. (Feldkirch, Austria)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: Treatment of male stress incontinence in patients with prostate cancer treated with radical prostatectomy and adjuvant pelvic radiation is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is not well established, despite the general belief that outcomes are worse than in patients without radiation. (2) Methods: Retrospective multicenter study evaluating patients treated with silicone-covered scrotal port (SSP) ATOMS implant after radical prostatectomy and radiotherapy in nine different institutions between 2016 and 2022. The primary endpoint was dry patient rate, defined as pad-test \u2264 20 mL\/day. The secondary endpoints were complication rate (defined using Clavien\u2013Dindo classification), device removal and self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank-sum test, Fisher\u2019s exact test and logistic regression were performed using stepwise method with a 0.15 entry and 0.1 stay criteria. (3) Results: 223 patients fulfilled the criteria for inclusion and 12 (5.4%) received salvage prostatectomy after radiation and 27 (12.1%) previous devices for stress incontinence. After ATOMS adjustment, 95 patients (42.6%) were dry and 36 (16.1%) had complications of any grade (grade I, n = 20; grade II, n = 11; grade III, n = 5) during the first 3 months postoperatively. At a mean of 36 \u00b1 21 months follow-up, the device was explanted in 26 (11.7%) patients. Regarding self-perceived satisfaction with the implant, 105 of 125 patients (84%) considered themselves satisfied (PGI-I 1 to 3). In the univariate analysis, dryness was associated to younger age (p = 0.06), primary prostatectomy (p = 0.08), no previous incontinence surgery (p = 0.02), absence of overactive bladder symptoms (p = 0.04), absence of bladder neck stricture (p = 0.001), no need of surgical revision (p = 0.008) and lower baseline incontinence severity (p = 0.0003). Multivariate analysis identified absence of surgical revision (p = 0.018), absence of bladder neck stricture (p = 0.05), primary prostatectomy (p = 0.07) and lower baseline incontinence severity (p &lt; 0.0001) were independent predictors of dryness. A logistic regression model was proposed and internally validated. (4) Conclusions: ATOMS is an efficacious and safe alternative to treat male incontinence after radical prostatectomy and adjuvant radiotherapy. Factors predictive of dryness are identified in this complex scenario to allow for better patient selection.<\/jats:p>","DOI":"10.3390\/jcm12144721","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T01:46:02Z","timestamp":1689644762000},"page":"4721","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Results of Adjustable Trans-Obturator Male System in Patients with Prostate Cancer Treated with Prostatectomy and Radiotherapy: A Multicenter Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1735-8792","authenticated-orcid":false,"given":"Javier C.","family":"Angulo","sequence":"first","affiliation":[{"name":"Clinical Department, Faculty of Biomedical Science, Universidad Europea, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain"},{"name":"Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain"}]},{"given":"Carlos","family":"T\u00e9llez","sequence":"additional","affiliation":[{"name":"Clinical Department, Faculty of Biomedical Science, Universidad Europea, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain"},{"name":"Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain"}]},{"given":"Alessandro","family":"Giamm\u00f2","sequence":"additional","affiliation":[{"name":"Department of Neuro-Urology, CTO\/Spinal Cord Unit, AOU Citt\u00e0 Della Salute e Della Scienza di Torino, Via Zuretti 24, 10126 Torino, Italy"}]},{"given":"Carmen","family":"Gonz\u00e1lez-Enguita","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Fundaci\u00f3n Jim\u00e9nez D\u00edaz, Av. de Los Reyes Cat\u00f3licos, 2, 28040 Madrid, Spain"}]},{"given":"Sandra","family":"Schoenburg","sequence":"additional","affiliation":[{"name":"Department of Urology and Kidney Transplantation, Martin Luther University, Ernst-Grube-Stra\u00dfe 40, 06120 Halle (Saale), Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2486-2740","authenticated-orcid":false,"given":"Fabian","family":"Queissert","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 M\u00fcnster, Germany"}]},{"given":"Juliusz","family":"Szczesniewski","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1375-4851","authenticated-orcid":false,"given":"Raquel","family":"Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Fundaci\u00f3n Jim\u00e9nez D\u00edaz, Av. de Los Reyes Cat\u00f3licos, 2, 28040 Madrid, Spain"}]},{"given":"Antonio","family":"Romero","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Universitario Morales Meseguer, Avd. Marqu\u00e9s de Los V\u00e9lez s\/n., 30008 Murcia, Spain"}]},{"given":"Andreas","family":"Gonsior","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Urologie, University of Leipzig, Liebigstra\u00dfe 20, 04103 Leipzig, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5718-6964","authenticated-orcid":false,"given":"Francisco E.","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Urology, Centro Hospitalar Universit\u00e1rio de Lisboa Norte, Hospital Santa Mar\u00eda, Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal"}]},{"given":"Tiago","family":"Antunes-Lopes","sequence":"additional","affiliation":[{"name":"Department of Urology, Centro Hospitalar S\u00e3o Jo\u00e3o and Faculty of Medicine of University Porto, Alameda Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"I3S Institute, R. Alfredo Allen 208, 4200-135 Porto, Portugal"}]},{"given":"Francisco","family":"Cruz","sequence":"additional","affiliation":[{"name":"Department of Urology, Centro Hospitalar S\u00e3o Jo\u00e3o and Faculty of Medicine of University Porto, Alameda Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"I3S Institute, R. Alfredo Allen 208, 4200-135 Porto, Portugal"}]},{"given":"Keith","family":"Rourke","sequence":"additional","affiliation":[{"name":"Department of Urology, Alberta University, Hospital Edmonton, 8440 112 St. NW, Edmonton, AB T6G 2B7, Canada"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1002\/pros.23496","article-title":"National trends in management of localized prostate cancer: A population based analysis 2004\u20132013","volume":"78","author":"Chen","year":"2018","journal-title":"Prostate"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.eururo.2008.06.059","article-title":"Adjuvant radiotherapy for patients with locally advanced prostate cancer\u2014A new standard?","volume":"54","author":"Ganswindt","year":"2008","journal-title":"Eur. 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