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Adjustable continence therapy (ProACT™) after male sling failure for patients with post-radical prostatectomy urinary incontinence: a prospective study with one-year follow-up

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To assess the effects of the ProACT™ device as a second-line treatment for persistent incontinence after male sling insertion.

Methods

Twenty consecutive patients were treated with the ProACT™ device due to persistent urinary incontinence following male sling insertion (9 AdVance™, 9 TOMS™, 2 InVance™). All balloons were implanted using a combination of fluoroscopic imaging and fibroscopic retrovision. Urinary symptoms were assessed prior to male sling insertion (T0) and before (T1) and 1 year after the ProACT™ insertion (T2) using questionnaires (ICIQ, USP, and ULCA-PCI-urinary bother) and by determining the number of pads used daily.

Results

The mean age of the study population at T1 was 68.6 ± 9 years. The mean volume of adjustment at T2 was 4.5 ± 2.7 mL. The previous sling did not cause any technical difficulties during ProACT™ insertion. Late wound infections occurred in the two patients who had been previously treated with the InVance sling and required removal of all implanted materials (Clavien–Dindo classification IIIb). Improvement in mean urinary scores was noted in the remaining patients (n = 18) through T0, T1, and T2, respectively: The ICIQ scores were 16.8 ± 2.6, 13.1 ± 3.4, and 5.7 ± 5.7 (P < 0.0001); USP stress urinary incontinence scores were 8 ± 1.8, 5.6 ± 2.2, and 2.4 ± 2.8, (P < 0.0001); USP overactive bladder symptom scores were 6.8 ± 4.3, 7.6 ± 4.3, and 4.1 ± 3.5 (P = 0.008), UCLA-PCI urinary bother scores were 7.1 ± 11.3, 28.6 ± 12.9, and 69.6 ± 31.6 (P < 0.0001), and number of pads used were 2.9 ± 1, 2 ± 1, and 0.3 ± 0.9 (P < 0.0001). USP obstructive symptoms were 0.4 ± 1, 1 ± 1.6, and 1.3 ± 1.4 (P = 0.19).

Conclusions

The Pro-ACT™ device may provide additional benefits for improving continence in case of persistent incontinence following male sling insertion.

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Conflict of interest

René Yiou is consultant for Uromedica and CL Medical.

Ethical statement

This study was approved by the ethics committee at our institution (Comité de Protection de la Personne Ile-de-France IX). All data were recorded anonymously in a database and declared to the Comité National de l’Informatique et des Libertés.

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Authors and Affiliations

  1. Créteil, France

    René Yiou, Zentia Butow, Thierry Baron, Laurent Salomon & Etienne Audureau

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  1. René Yiou
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  2. Zentia Butow
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  3. Thierry Baron
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  4. Laurent Salomon
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  5. Etienne Audureau
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Corresponding author

Correspondence to René Yiou.

Electronic supplementary material

“Implantation of adjustable continence therapy (ProACT) using fluoroscopy and fibroscopic retrovision for male incontinence”

The trocar is introduced through the perineal incision under fluoroscopic imaging and fibroscopic control.

The trocar moves parallel to the urethra until it elevates the trigone.

After confirming its position, the balloon is filled with 1 mL of isotonic contrast solution.

The procedure is repeated on the contralateral side for the second balloon. Fibroscopic retrovision is used to control the absence of bladder perforation.

We verify that the two balloons are symmetrical and the second balloon is inflated.

Below is the link to the electronic supplementary material.

Supplementary material 1 (MOV 3578 kb)

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Yiou, R., Butow, Z., Baron, T. et al. Adjustable continence therapy (ProACT™) after male sling failure for patients with post-radical prostatectomy urinary incontinence: a prospective study with one-year follow-up. World J Urol 33, 1331–1336 (2015). https://doi.org/10.1007/s00345-014-1447-6

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  • DOI: https://doi.org/10.1007/s00345-014-1447-6

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