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Behandlung der Belastungsinkontinenz nach radikaler Prostatektomie

Adjustierbares transobturatorisches System – prospektive multizentrische Anwendungsbeobachtung

Treatment of stress urinary incontinence after radical prostatectomy

Adjustable transobturator male system – results of a multicenter prospective observational study

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Zusammenfassung

Hintergrund

Das adjustierbare transobturatorische Männersystem (ATOMS®) ist eine neuartige Methode zur Behandlung der männlichen Belastungsinkontinenz. Wir präsentieren die Ergebnisse einer prospektiven multizentrischen Anwendungsstudie mit diesem System.

Patienten und Methoden

Zwischen März 2009 und März 2011 erhielten insgesamt 124 Patienten mit anhaltender Belastungsinkontinenz nach radikaler Prostatektomie das ATOMS. Postoperative Adjustierungen erfolgten bei Bedarf über die implantierte Portkammer ab der 6. Woche. Postoperative Evaluation bestand aus Anamnese, Miktionsprotokoll, 24-h-Pad-Test, 24-h-Vorlagenzahl, und Sonographie.

Ergebnisse

Das mittlere Alter der Patienten lag bei 71,2 ±5,5 (58–85) Jahren. Vorangegangene Inkontinenzoperationen lagen bei 36,3% der Patienten vor, während 34,5% der Patienten eine vorhergehende Bestrahlung hatten. Die mittlere Operationszeit betrug 48,3±11,2 (36–116) min. Die mittlere Krankenhausaufenthaltsdauer war 3,8±1,2 (2–6) Tage. Intraoperativ traten keine Harnröhren- oder Blasenverletzungen auf. Nach Entfernung des Blasenverweilkatheters am 1. postoperativen Tag traten 3 Fälle von temporärem Harnverhalt auf, die konservativ behandelbar waren. Transiente perineale/skrotale Sensibilitätsstörungen oder Schmerzen wurden bei 75 Patienten (60,5%) beobachtet, waren jedoch mit oralen Analgetika gut behandelbar und sistierten nach 3–4 Wochen. Perineale Infektionen traten nicht auf, während Wundinfektionen im Portbereich bei drei Patienten (2,4%) zur Explantation des Systems führten. Die durchschnittliche Anzahl der Adjustierungen zum Erreichen der gewünschten Ergebnisse war 4,3±1,8 (2–7). Nach einer mittleren Beobachtungszeit von 19,1±2,2 (12–36) Monaten kam es zu einer Reduktion der mittleren Vorlagenzahl/24 h von 8,8 auf 1,8 (p<0,001). Die Erfolgsrate betrug 93,8%, wobei 61,6% trocken wurden und 32,2% sich verbesserten.

Schlussfolgerung

Die Behandlung der Belastungsinkontinenz nach radikaler Prostatektomie mit dem ATOMS®-System ist sicher und effektiv.

Abstract

Background

The adjustable transobturator male system (ATOMS®) is a new method for the treatment of male stress urinary incontinence. This article presents the results of a prospective multicenter observational study with this system.

Patients and methods

Between March 2009 and March 2011 a total of 124 patients with persistent stress urinary incontinence after radical prostatectomy received the ATOMS system. Postoperative adjustments via the implanted port chamber were performed after 6 weeks and thereafter when necessary. Postoperative evaluation consisted of medical history, mictionary protocol, 24-h pad tests, 24-h pad counts and sonography.

Results

The mean age of the patients was 71.2±5.5 years (range 58-85 years). Previous incontinence surgery had been carried out in 36.3% of patients while 34.5% of patients had a previous history of radiation treatment. The mean operation time was 48.3±11.2 min (range 36-116 min) and the mean hospital stay was 3.8±1.2 days (range 2-6 days). No intraoperative urethral or bladder injuries occurred. After removal of the transurethral catheter on the first postoperative day, temporary urinary retention occurred in 3 patients who were conservatively treated. Transient perineal/scrotal pain or dysesthesia was observed in 75 patients (60.5%) and resolved after 3-4 weeks of non-opioid analgesics. There were no perineal infections; however, infections at the port site occurred in 3 patients (2.4%) leading to explantation of the system in all cases. The average number of adjustments to achieve the desired result was 4.3±1.8 (range 2-7). After a mean follow-up of 19.1±2.2 months (range 12-36 months), there was a significant reduction in the mean number of pads/24 h from 8.8 to 1.8 (p<0.001). The overall success rate was 93.8% with 61.6% of the patients being dry and 32.2% of the patients showing improvement.

Conclusions

The results of the study demonstrate the safety and efficacy to date of the ATOMS system for treatment of stress urinary incontinence after radical prostatectomy.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: Dr. W. Bauer und PD Dr. med. M.R. Hoda sind als Referent für die Firma AMI (Österreich und Deutschland) tätig.

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Authors and Affiliations

  1. Klinik für Urologie und Nierentransplantation, Martin Luther-Universität Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland

    M.R. Hoda, A. Schumann & P. Fornara

  2. Universitätsklinik für Urologie, Medizinische Universität Graz, Graz, Österreich

    G. Primus & K. Fischereder

  3. Urologische Klinik, SLK-Kliniken Heilbronn, Bad Friedrichshall, Deutschland

    B. von Heyden

  4. Urologische Klinik, Hospital Wels-Grieskirchen, Wels, Österreich

    N. Schmid

  5. Diako-Die Stadtklinik, Augsburg, Deutschland

    V. Moll

  6. Urologische Klinik, St. Georg Krankenhaus, Leipzig, Deutschland

    A. Hamza

  7. Urologische Klinik, Loretto Krankenhaus, Freiburg, Deutschland

    J.J. Karsch

  8. Urologische Klinik, Krankenhaus Dresden-Friedrichstadt, Dresden, Deutschland

    F. Steinbach

  9. Urologische Klinik, Krankenhaus Göttlicher Heiland, Wien, Österreich

    C. Brössner & W. Bauer

Authors
  1. M.R. Hoda
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  2. G. Primus
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  3. A. Schumann
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  4. K. Fischereder
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  6. N. Schmid
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  7. V. Moll
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  8. A. Hamza
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  10. F. Steinbach
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  11. C. Brössner
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  12. W. Bauer
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  13. P. Fornara
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Corresponding author

Correspondence to M.R. Hoda.

Additional information

M.R. Hoda und G. Primus haben geteilte Autorenschaft.

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Hoda, M., Primus, G., Schumann, A. et al. Behandlung der Belastungsinkontinenz nach radikaler Prostatektomie. Urologe 51, 1576–1583 (2012). https://doi.org/10.1007/s00120-012-2950-2

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  • DOI: https://doi.org/10.1007/s00120-012-2950-2

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