PONE-D-19-26165

Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and Adjustable Continence Therapy (ProACT) for male stress incontinence.

PLOS ONE

Dear Dr Angulo,

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Additional Editor Comments (if provided):

Dear authors,

In addition to the reviewers comments: Can you add an explanation for 'previous surgery' in the table. The search strategy as is reported in the manuscripts core tekst is fairly specific: have you missed publications because you seached brand names only? and or only "urinary incontinence" (word combination within quotation marks?) and or, preferably: add the search strategy to the supplements. Furthermore have you checked/controlled or corrected (N patients reported) for the fact that some publications may (partially) contain the same patient cohorts? And also; can you limit your discussion and conclusion more to what you found and concluded in your analysis. Comments about future research should be placed in the discussion and the discussion should not include e.g. 'technical' differences; this, as example, has not been the topic of your research. The sentence (discussion) '...current evidence is still low' should be made more specific; the (discussion and) conclusion could/should include a statement about the overall risk of bias in the publications (e.g. the proportion of retrospective or quasi prospective single center uncontrolled cohorts).

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Summary:

This systematic review compares two techniques for non-neurogenic male stress incontinence that can be adjusted post-operatively: ATOMS and ProACT. Efficacy and safety aspects were considered. The study was well performed and the manuscript is well written.

The conclusion was that ATOMS has better efficacy and a lower complication and explantation rate. It must however be noted that the ATOMS studies had a shorter follow-up than the ProACT studies (20.8 vs 30.6 months on average) and that the severity of complications was not described, only the complication rate. ProACT placement is a less invasive procedure than ATOMS placement. This is summarily hinted in the Discussion, but not described quantitatively. Nevertheless, the comparison of ProACT and ATOMS is fairly described.

Comments:

1. There are some typing errors throughout the manuscript, e.g., grupo instead of group. Also, sometimes a word is missing.

2. Results. The authors write: The main etiology of incontinence was prostatectomy but other causes were included. I assume they mean radical prostatectomy (RP) and not Millin or TURP. Can the authors report the percentages of men with RP in both the ATOMS and ProACT group? Are they comparable?

3. The authors write NA in Table 2. This probably means Not Applicable, but I think NR (Not Reported) would be better.

Reviewer #2: The authors present an interesting and important paper on male postprostatectomy incontinence. Two widely used devices are compared in this meta analysis and the results are presented clearely. Since there is only consensus, that the artifical sphincter should be considered gold standard, it ist important to evaluate the other existing devices. Especially since the artifical sphincter is not the ideal solution for every patient.

Minor spelling mistakes in the paper can easily be fixed. Nevertheless, one comment must be allowed. It would be useful and interesting, if not only the putcome parameters, but also patients characteristics would be compared. All studies have provided statistics concerning their patients like age and type of prior operation. Here the authors should show, that there are no significant differences between ProAct and Atoms groups, since this would make the conclusion stronger.

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Reviewer #1: Yes: Jan Groen

Reviewer #2: Yes: Sebastian Nestler, UroGate

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Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and Adjustable Continence Therapy (ProACT) for male stress incontinence.

PONE-D-19-26165R1

Dear Dr. Angulo,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

Peter F.W.M. Rosier, M.D. PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Maybe you can follow the suggestion of reviewer 1; Q6, to mention the follow up duration in the abstract, I would be in favour of that.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: It would have been my preference to mention the mean follow-up durations not only in the article itself, but also in the abstract.

Reviewer #2: All comments have been adressed, I have no further questions or comments. The paper should be published

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Jan Groen

Reviewer #2: No