World Journal of Urology

, Volume 33, Issue 9, pp 1331–1336 | Cite as

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

  • René Yiou
  • Zentia Butow
  • Thierry Baron
  • Laurent Salomon
  • Etienne Audureau
Original Article



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


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.


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).


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


Male urinary incontinence Radical prostatectomy Continence device 


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.

Supplementary material (3.5 mb)
Supplementary material 1 (MOV 3578 kb)


  1. 1.
    Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, Menon M, Montorsi F, Patel VR, Stolzenburg JU, Van der Poel H, Wilson TG, Zattoni F, Mottrie A (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62(3):405–417CrossRefPubMedGoogle Scholar
  2. 2.
    Bauer RM, Gozzi C, Hubner W, Nitti VW, Novara G, Peterson A, Sandhu JS, Stief CG (2011) Contemporary management of postprostatectomy incontinence. Eur Urol 59(6):985–996CrossRefPubMedGoogle Scholar
  3. 3.
    Herschorn S, Bruschini H, Comiter C, Grise P, Hanus T, Kirschner-Hermanns R, Abrams P, Committee of the International Consultation on I (2010) Surgical treatment of stress incontinence in men. Neurourol Urodyn 29(1):179–190CrossRefPubMedGoogle Scholar
  4. 4.
    Rehder P, Haab F, Cornu JN, Gozzi C, Bauer RM (2012) Treatment of postprostatectomy male urinary incontinence with the transobturator retroluminal repositioning sling suspension: 3-year follow-up. Eur Urol 62(1):140–145CrossRefPubMedGoogle Scholar
  5. 5.
    Lentz AC, Peterson AC, Webster GD (2012) Outcomes following artificial sphincter implantation after prior unsuccessful male sling. J Urol 187(6):2149–2153CrossRefPubMedGoogle Scholar
  6. 6.
    Al-Najar A, Kaufmann S, Boy S, Naumann CM, Junemann PK, Van Der Horst C (2011) Management of recurrent post-prostatectomy incontinence after previous failed retrourethral male slings. Can Urol Assoc J 5(2):107–111PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Lebret T, Cour F, Benchetrit J, Grise P, Bernstein J, Delaporte V, Chartier-Kastler E, Botto H, Costa P (2008) Treatment of postprostatectomy stress urinary incontinence using a minimally invasive adjustable continence balloon device, ProACT: results of a preliminary, multicenter, pilot study. Urology 71(2):256–260CrossRefPubMedGoogle Scholar
  8. 8.
    Roupret M, Misrai V, Gosseine PN, Bart S, Cour F, Chartier-Kastler E (2011) Management of stress urinary incontinence following prostate surgery with minimally invasive adjustable continence balloon implants: functional results from a single center prospective study. J Urol 186(1):198–203CrossRefPubMedGoogle Scholar
  9. 9.
    Trigo-Rocha F, Gomes CM, Pompeo AC, Lucon AM, Arap S (2006) Prospective study evaluating efficacy and safety of adjustable continence therapy (ProACT) for post radical prostatectomy urinary incontinence. Urology 67(5):965–969CrossRefPubMedGoogle Scholar
  10. 10.
    Hubner WA, Schlarp OM (2005) Treatment of incontinence after prostatectomy using a new minimally invasive device: adjustable continence therapy. BJU Int 96(4):587–594CrossRefPubMedGoogle Scholar
  11. 11.
    Hubner WA, Schlarp OM (2007) Adjustable continence therapy (ProACT): evolution of the surgical technique and comparison of the original 50 patients with the most recent 50 patients at a single centre. Eur Urol 52(3):680–686CrossRefPubMedGoogle Scholar
  12. 12.
    Cornu JN, Sebe P, Ciofu C, Peyrat L, Beley S, Tligui M, Lukacs B, Traxer O, Cussenot O, Haab F (2009) The AdVance transobturator male sling for postprostatectomy incontinence: clinical results of a prospective evaluation after a minimum follow-up of 6 months. Eur Urol 56(6):923–927CrossRefPubMedGoogle Scholar
  13. 13.
    Castle EP, Andrews PE, Itano N, Novicki DE, Swanson SK, Ferrigni RG (2005) The male sling for post-prostatectomy incontinence: mean followup of 18 months. J Urol 173(5):1657–1660CrossRefPubMedGoogle Scholar
  14. 14.
    Leruth J, Waltregny D, de Leval J (2012) The inside-out transobturator male sling for the surgical treatment of stress urinary incontinence after radical prostatectomy: midterm results of a single-center prospective study. Eur Urol 61(3):608–615CrossRefPubMedGoogle Scholar
  15. 15.
    Vayleux B, Luyckx F, Thelu S, Rigaud J, Bouchot O, Karam G, Le Normand L (2010) Adjustable continence therapy in women, middle term follow-up and a new technique for balloon positioning. Prog Urol 20(7):520–526CrossRefPubMedGoogle Scholar
  16. 16.
    Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Brook RH (1998) The UCLA Prostate Cancer Index: development, reliability, and validity of a health-related quality of life measure. Med Care 36(7):1002–1012CrossRefPubMedGoogle Scholar
  17. 17.
    Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P (2004) ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23(4):322–330CrossRefPubMedGoogle Scholar
  18. 18.
    Cornu JN, Sebe P, Ciofu C, Peyrat L, Beley S, Tligui M, Lukacs B, Traxer O, Cussenot O, Haab F (2009) The AdVance transobturator male sling for postprostatectomy incontinence: clinical results of a prospective evaluation after a minimum follow-up of 6 months. Eur Urol 56(6):923–927CrossRefPubMedGoogle Scholar
  19. 19.
    Haab F, Richard F, Amarenco G, Coloby P, Arnould B, Benmedjahed K, Guillemin I, Grise P (2008) Comprehensive evaluation of bladder and urethral dysfunction symptoms: development and psychometric validation of the Urinary Symptom Profile (USP) questionnaire. Urology 71(4):646–656CrossRefPubMedGoogle Scholar
  20. 20.
    de Leval J, Waltregny D (2008) The inside-out trans-obturator sling: a novel surgical technique for the treatment of male urinary incontinence. Eur Urol 54(5):1051–1065CrossRefPubMedGoogle Scholar
  21. 21.
    Bauer RM, Mayer ME, Gratzke C, Soljanik I, Buchner A, Bastian PJ, Stief CG, Gozzi C (2009) Prospective evaluation of the functional sling suspension for male postprostatectomy stress urinary incontinence: results after 1 year. Eur Urol 56(6):928–933CrossRefPubMedGoogle Scholar
  22. 22.
    Grise P, Vautherin R, Njinou-Ngninkeu B, Bochereau G, Lienhart J, Saussine C (2012) I-STOP TOMS transobturator male sling, a minimally invasive treatment for post-prostatectomy incontinence: continence improvement and tolerability. Urology 79(2):458–463CrossRefPubMedGoogle Scholar
  23. 23.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Giammo A, Bodo G, Castellano S, Borre A, Carone R (2010) Spiral multidetector computerized tomography evaluation of adjustable continence therapy implants. J Urol 183(5):1921–1926CrossRefPubMedGoogle Scholar
  25. 25.
    Gregori A, Galli S, Kartalas IG, Scieri F, Stener S, Incarbone GP, Gaboardi F (2008) Implantation of an adjustable continence therapy system using local anesthesia in patients with post-radical prostatectomy stress urinary incontinence: a pilot study. J Urol 179(5):1902–1906CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • René Yiou
    • 1
  • Zentia Butow
    • 1
  • Thierry Baron
    • 1
  • Laurent Salomon
    • 1
  • Etienne Audureau
    • 1
  1. 1.CréteilFrance

Personalised recommendations