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Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and male Readjustment Mechanical External (REMEEX) system for post-prostatectomy incontinence

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Abstract

Objective

To assess the efficacy and safety of Adjustable Transobturator Male System (ATOMS) compared to male Readjustment Mechanical External (REMEEX) system for post-prostatectomy incontinence (PPI).

Material and methods

A systematic review and meta-analysis on adjustable device ATOMS compared to male REMEEX is presented. Studies on female or neurogenic incontinence were excluded. Primary objectives were evaluation of dryness (the proportion of patients with no-pad or one safety pad/day after device adjustment) and improvement between devices. Secondary objectives were complications and explant rate. They were estimated using a random-effect model. Statistical heterogeneity among studies was assessed using Cochran’s Q test, Higgins’s I2 statistics and tau2.

Results

Combined data of 29 observational studies with 1919 patients showed an equivalent proportion of patients treated with radical prostatectomy (p = .125) and previous radiation (p = .126). Dryness rate was 69.3% for ATOMS and 53.4% for male REEMEX (p = .008). Improvement rate was 90.8% for ATOMS and 80.2% for REMEEX (p = .007). Complication rate was 18.9% for ATOMS and 35.8% for REMEEX (p = .096) and explant rate was 5.5% for ATOMS and 13.9% for REMEEX (p = .027). Significant heterogeneity was evidenced, due to absence of randomized studies, variable incontinence severity baseline, difficulties for a common reporting of complications and difference in the follow-up. Differences observed between devices remained statistically significant when only studies with silicone-covered scrotal port (SSP) ATOMS and male REMEEX system II were considered.

Conclusions

Despite the absence of direct comparison and the limitations observed ATOMS appears more effective than male REMEEX to treat PPI, and with less explant rate as reported in the literature.

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Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Departamento Clínico, Universidad Europea de Madrid, Madrid, Spain

    Javier C. Angulo, Sonia Ruiz, Martín Lozano, Ignacio Arance & Miguel Virseda

  2. Servicio de Urología, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, 28905, Madrid, Spain

    Javier C. Angulo, Sonia Ruiz, Martín Lozano, Ignacio Arance & Miguel Virseda

  3. Instituto de Investigación Sanitaria Hospital “12 de Octubre” (i+12), CIBER de Epidemiología y Salud Pública (CIBERESP), Universidad Complutense de Madrid, 28041, Madrid, Spain

    David Lora

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Contributions

JCA: project development, data collection, data analysis, manuscript writing. SR: data collection, manuscript writing. ML: project development, data collection, data analysis, manuscript writing. IA: data collection, manuscript writing. MV: project development, manuscript writing. DL: project development, data collection, data analysis, manuscript writing.

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Correspondence to Javier C. Angulo.

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The authors have declared that no competing interests exist. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. All named declare that they have no conflict of interest. Compliance with ethics guidelines: This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.

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S1. Table. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 Checklist (DOCX 26 kb)

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S2. Table. Newcastle–Ottawa scale for assessing the quality of cohort studies included in the meta-analysis (DOCX 18 kb)

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Angulo, J.C., Ruiz, S., Lozano, M. et al. Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and male Readjustment Mechanical External (REMEEX) system for post-prostatectomy incontinence. World J Urol 39, 1083–1092 (2021). https://doi.org/10.1007/s00345-020-03300-1

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