atoms device for male urinary incontinence: a readjustable and reproducible system dr.emilio...
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ATOMSATOMSDEVICE FOR MALE DEVICE FOR MALE
URINARY INCONTINENCE: URINARY INCONTINENCE: A READJUSTABLE AND A READJUSTABLE AND
REPRODUCIBLE SYSTEMREPRODUCIBLE SYSTEM
DR.EMILIO GUTIERREZ MINGUEZDR.EMILIO GUTIERREZ MINGUEZ
Department of UrologyDepartment of Urology
HOSPITAL UNIVERSITARIO DE BURGOSHOSPITAL UNIVERSITARIO DE BURGOS
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ETIOLOGY OF INCONTINENCEETIOLOGY OF INCONTINENCE
• NEUROGENIC BLADDER.NEUROGENIC BLADDER.
• EVOLUTIONARY PROSTATICS.EVOLUTIONARY PROSTATICS.
• RADICAL PROSTATECTOMY.RADICAL PROSTATECTOMY.
• TURP / ADENOMECTOMY PROSTATE.TURP / ADENOMECTOMY PROSTATE.
• RADIOTHERAPY.RADIOTHERAPY.
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FRECUENCYFRECUENCY
THE MOST COMMON CAUSE THE MOST COMMON CAUSE IS RADICAL PROSTATECTOMYIS RADICAL PROSTATECTOMY
(between 6 and 60 % with a (between 6 and 60 % with a mean of 14%)mean of 14%)
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THERAPEUTIC DEVICESTHERAPEUTIC DEVICES
• REEMEXREEMEX
• ARGUSARGUS
• PRO-ACTPRO-ACT
• ARTIFICIAL SPHINCTER AMS 800ARTIFICIAL SPHINCTER AMS 800
• ARTIFICIAL SPHINCTER FLOWSECUREARTIFICIAL SPHINCTER FLOWSECURE
• ADVANCEADVANCE
• ATOMSATOMS
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ATOMS SYSTEM: INDICATIONSATOMS SYSTEM: INDICATIONS
• RADICAL PROSTATECTOMY WITH OR RADICAL PROSTATECTOMY WITH OR WITHOUT RADIOTHERAPY.WITHOUT RADIOTHERAPY.
• RETROPUBIC ADENOMECTOMY.RETROPUBIC ADENOMECTOMY.
• TURP OR MIST PROSTATICTURP OR MIST PROSTATIC
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ATOMS SYSTEM: ATOMS SYSTEM: PREOPERATIVEPREOPERATIVE
• SONOGRAPHY.SONOGRAPHY.
• CYSTOGRAPHY.CYSTOGRAPHY.
• FLOWMETER.FLOWMETER.
• URETHROCYSTOSCOPY.URETHROCYSTOSCOPY.
• ¿ URODYNAMIC STUDY ?¿ URODYNAMIC STUDY ?
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ATOMS SYSTEM:ATOMS SYSTEM:CONTRAINDICATIONS.CONTRAINDICATIONS.
• RESIDUAL URINE.RESIDUAL URINE.
• RECURRENT URINARY TRACT RECURRENT URINARY TRACT INFECTIONS.INFECTIONS.
• URINARY FISTULA.URINARY FISTULA.
• IMMUNOSUPPRESSION.IMMUNOSUPPRESSION.
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ATOMS SYSTEM:ATOMS SYSTEM:CASUISTRYCASUISTRY
OPERATE: 51 PATIENTS.OPERATE: 51 PATIENTS.
45 RADICAL PROSTATECTOMY (14 45 RADICAL PROSTATECTOMY (14 TREATMENT OF RADIOTHERAPY TREATMENT OF RADIOTHERAPY ADJUVANT ).ADJUVANT ).
2 RETROPUBIC ADENOMECTOMY2 RETROPUBIC ADENOMECTOMY
1 PROSTATE LASER1 PROSTATE LASER
3 TUR PROSTATE3 TUR PROSTATE
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ATOMS SYSTEM:ATOMS SYSTEM:INCONTINENCE RANK.INCONTINENCE RANK.
• 33 SEVERE INCONTINENCE( + 3 pads 33 SEVERE INCONTINENCE( + 3 pads daily).daily).
• 16 MODERATE INCONTINENCE (1-3 16 MODERATE INCONTINENCE (1-3 pads daily).pads daily).
• 2 MILD INCONTINENCE.2 MILD INCONTINENCE.
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ATOMS SYSTEMATOMS SYSTEM
• MEAN AGE:68 YEARS MEAN AGE:68 YEARS
• AVERAGE SURGICAL TIME: 55 MINUTESAVERAGE SURGICAL TIME: 55 MINUTES
• FOLLOW-UP: 24 MONTHSFOLLOW-UP: 24 MONTHS
• AVERAGE FILLING PORT:18cc (CAPACITY 27cc.)AVERAGE FILLING PORT:18cc (CAPACITY 27cc.)
• 17 % (9 PATIENTS) NO FILLING OUTPATIENT17 % (9 PATIENTS) NO FILLING OUTPATIENT
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ATOMS SYSTEM:ATOMS SYSTEM:RESULTS.RESULTS.
• 85% TOTALLY DRY, NO ABSORBENT 85% TOTALLY DRY, NO ABSORBENT NEEDED (INCLUDING SEVERE NEEDED (INCLUDING SEVERE INCONTINENCE) INCONTINENCE)
• 11% GREAT IMPROVEMENT 11% GREAT IMPROVEMENT INCONTINENCE ( 1 PAD DAILY).INCONTINENCE ( 1 PAD DAILY).
• 4 % WITH MINOR IMPROVEMENT. 4 % WITH MINOR IMPROVEMENT.
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PORT POSITIONPORT POSITION
•ABDOMINAL: 37 PATIENTS (73%)ABDOMINAL: 37 PATIENTS (73%)
•SCROTAL: 14 PATIENTS (27%)SCROTAL: 14 PATIENTS (27%)
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ATOMS SYSTEM:ATOMS SYSTEM:COMPLICATIONS.COMPLICATIONS.
• 3 URINARY RETENTION (48 HOURS 3 URINARY RETENTION (48 HOURS CATHETER).CATHETER).
• 7 SURGICAL ABDOMINAL WOUND 7 SURGICAL ABDOMINAL WOUND INFECTION, REMOVAL TITANIUM INFECTION, REMOVAL TITANIUM PORT.PORT.
• 3 FULL SYSTEM INFECTIONS3 FULL SYSTEM INFECTIONS
• 1 TESTICULAR PAIN 2 MONTHS 1 TESTICULAR PAIN 2 MONTHS (EPIDIDYMITIS)(EPIDIDYMITIS)
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ATOMS SYSTEM:ATOMS SYSTEM:ADVANTAGESADVANTAGES
• MINIMALLY INVASIVE SURGERYMINIMALLY INVASIVE SURGERY• REPRODUCIBLEREPRODUCIBLE• SUBURETHRAL CONSTANT PRESSURE SUBURETHRAL CONSTANT PRESSURE
DISTRIBUTION DISTRIBUTION • POSTOPERATIVELY READJUSTABLEPOSTOPERATIVELY READJUSTABLE• EFFECTIVE FOR ALL GRADES OF EFFECTIVE FOR ALL GRADES OF
INCONTINENCEINCONTINENCE• IDEAL FOR RADIATED PATIENTS IDEAL FOR RADIATED PATIENTS • PHYSIOLOGICAL URINATION WITHOUT PHYSIOLOGICAL URINATION WITHOUT
NEED FOR MECHANICAL HANDLINGNEED FOR MECHANICAL HANDLING