Skip to main content

Advertisement

SpringerLink
Log in

Adjustable continence therapy (proACT) for the treatment of male stress urinary incontinence post-prostatectomy: a systematic review and meta-analysis (2023 update)

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Stress urinary incontinence (SUI) is a key factor for post-prostatectomy (RP) quality of life. Current international guidelines struggle to find the adequate place for each kind of surgeries. The aim of this systematic review and meta-analysis considering updated evidence is to assess the efficacy and safety of proACT in treating male patients with post-RP SUI.

Methods

A review of the literature was performed by searching the PubMed database. We narrowed included studies with adult male patients with SUI; outcomes included pads or pad weight per day and quality of life (QOL) questionnaires, as well as safety outcomes.

Results

18 studies involving 1570 patients mean age of 68.8 (EC 2.1) were included. The mean follow-up reported was 34.7 months (EC 17.7; median 38.5; range 1–128 months). An average of 60.7% (EC 27) and 40.4% of patients suffered from mild-to-moderate and severe incontinence, respectively. The overall dryness rate was 55.1% (EC 19.3) while respecting the definition of 0–1 pads per day, and the mean dryness rate was 53% (EC 0.2). The mean overall complication rate was 31.2% (EC 18.3%), including an explantation rate of 26.5% (EC 15.3) and a reoperation rate of 22.7% (EC 8.7). The methodological quality of the 18 studies was very heterogeneous.

Conclusion

Implantation of proACT adjustable balloons is a minimally invasive technique that provides medium outcomes (53%) with a strict definition of dryness (0–1 PPD) and important complication rate (31.2%). Past of irradiation is a negative predictive factor for incontinence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data that support the findings privacy or other restrictions of this study are available on request from the corresponding author [TT].

References

  1. Coyne KS, Kvasz M, Ireland AM et al (2012) Urinary incontinence and its relationship to mental health and health-related quality of life in men and women in Sweden, the UK, and the US. Eur Urol 61:88–95. https://doi.org/10.1016/j.eururo.2011.07.049

    Article  PubMed  Google Scholar 

  2. Köhler N, Friedrich M, Gansera L et al (2014) Psychological distress and adjustment to disease in patients before and after radical prostatectomy. Results of a prospective multi-centre study. Eur J Cancer Care (Engl) 23:795–802. https://doi.org/10.1111/ecc.12186

    Article  PubMed  Google Scholar 

  3. Crivellaro S, Morlacco A, Bodo G et al (2016) Systematic review of surgical treatment of post radical prostatectomy stress urinary incontinence. Neurourol Urodyn 35:875–881. https://doi.org/10.1002/nau.22873

    Article  PubMed  Google Scholar 

  4. Haglind E, Carlsson S, Stranne J et al (2015) Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective, controlled, nonrandomised trial. Eur Urol 68:216–225. https://doi.org/10.1016/j.eururo.2015.02.029

    Article  PubMed  Google Scholar 

  5. Anderson CA, Omar MI, Campbell SE, et al (2015) Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev 1:CD001843. https://doi.org/10.1002/14651858.CD001843.pub5

  6. Cornu JN EAU Guidelines on the Management of Non-neurogenic Male LUTS - DISEASE MANAGEMENT - Uroweb. In: Uroweb - European Association of Urology. https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts/chapter/disease-management. Accessed 30 Sep 2022

  7. Jaspreet SS Incontinence after Prostate Treatment: AUA/SUFU Guideline (2019) - American Urological Association. https://www.auanet.org/guidelines-and-quality/guidelines/incontinence-after-prostate-treatment. Accessed 20 Feb 2023

  8. Chen Y-C, Lin P-H, Jou Y-Y, Lin VC-H (2017) Surgical treatment for urinary incontinence after prostatectomy: a meta-analysis and systematic review. PLoS One 12:e0130867. https://doi.org/10.1371/journal.pone.0130867

  9. Martens F, Van der Aa F, Heesakkers J, et al (2022) Prospective multi center registry for patients undergoing surgery for male stress urinary incontinence (saturn): 1 year follow-up in 500 patients. Continence 2:100191. https://doi.org/10.1016/j.cont.2022.100191

  10. Kretschmer A, Hüsch T, Thomsen F et al (2017) Targeting moderate and severe male stress urinary incontinence with adjustable male slings and the perineal artificial urinary sphincter: focus on perioperative complications and device explantations. Int Neurourol J 21:109–115. https://doi.org/10.5213/inj.1632626.313

    Article  PubMed  PubMed Central  Google Scholar 

  11. Larson T, Jhaveri H, Yeung LL (2019) Adjustable continence therapy (ProACT) for the treatment of male stress urinary incontinence: a systematic review and meta-analysis. Neurourol Urodyn 38:2051–2059. https://doi.org/10.1002/nau.24135

    Article  PubMed  Google Scholar 

  12. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  13. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605. https://doi.org/10.1007/s10654-010-9491-z

    Article  PubMed  Google Scholar 

  14. Gilling PJ, Bell DF, Wilson LC, et al (2008) An adjustable continence therapy device for treating incontinence after prostatectomy: a minimum 2-year follow-up. BJU Int 102:1426–1430 (discussion 1430–1431). https://doi.org/10.1111/j.1464-410X.2008.07816.x

  15. Hübner WA, Schlarp OM (2005) Treatment of incontinence after prostatectomy using a new minimally invasive device: adjustable continence therapy. BJU Int 96:587–594. https://doi.org/10.1111/j.1464-410X.2005.05689.x

    Article  PubMed  Google Scholar 

  16. Crivellaro S, Singla A, Aggarwal N et al (2008) Adjustable continence therapy (ProACT) and bone anchored male sling: comparison of two new treatments of post prostatectomy incontinence. Int J Urol 15:910–914. https://doi.org/10.1111/j.1442-2042.2008.02161.x

    Article  PubMed  Google Scholar 

  17. Finazzi Agrò E, Gregori A, Bianchi D et al (2019) Efficacy and safety of adjustable balloons (Proact™) to treat male stress urinary incontinence after prostate surgery: Medium and long-term follow-up data of a national multicentric retrospective study. Neurourol Urodyn 38:1979–1984. https://doi.org/10.1002/nau.24103

    Article  PubMed  Google Scholar 

  18. Munier P, Nicolas M, Tricard T, et al (2020) What if artificial urinary sphincter is not possible? Feasibility and effectiveness of ProACT for patients with persistent stress urinary incontinence after radical prostatectomy treated by sling. Neurourol Urodyn. https://doi.org/10.1002/nau.24355

  19. Nash S, Aboseif S, Gilling P et al (2019) Four-year follow-up on 68 patients with a new post-operatively adjustable long-term implant for post-prostatectomy stress incontinence: ProACT™. Neurourol Urodyn 38:248–253. https://doi.org/10.1002/nau.23838

    Article  PubMed  Google Scholar 

  20. Noordhoff TC, Scheepe JR, Blok BFM (2018) Outcome and complications of adjustable continence therapy (ProACT™) after radical prostatectomy: 10 years’ experience in 143 patients. Neurourol Urodyn 37:1419–1425. https://doi.org/10.1002/nau.23463

    Article  PubMed  Google Scholar 

  21. Ricard H, Léon G, Branchereau J et al (2022) Adjustable continence balloons in postprostatectomy incontinence: outcomes and complications. Neurourol Urodyn 41:1414–1422. https://doi.org/10.1002/nau.24967

    Article  CAS  PubMed  Google Scholar 

  22. Kjær L, Fode M, Nørgaard N et al (2012) Adjustable continence balloons: clinical results of a new minimally invasive treatment for male urinary incontinence. Scand J Urol Nephrol 46:196–200. https://doi.org/10.3109/00365599.2012.660986

    Article  PubMed  Google Scholar 

  23. Kocjancic E, Crivellaro S, Ranzoni S et al (2007) Adjustable continence therapy for the treatment of male stress urinary incontinence: a single-centre study. Scand J Urol Nephrol 41:324–328. https://doi.org/10.1080/00365590601153488

    Article  PubMed  Google Scholar 

  24. Rouprêt M, Misraï V, Gosseine P-N et al (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 186:198–203. https://doi.org/10.1016/j.juro.2011.03.016

    Article  PubMed  Google Scholar 

  25. Crivellaro S, Tosco L, Palazzetti A et al (2012) Geometrical stepper-guided navigation system for ProACT implant under transrectal ultrasound control: preliminary data. Urol Int 89:473–479. https://doi.org/10.1159/000341991

    Article  PubMed  Google Scholar 

  26. Martens FMJ, Lampe MI, Heesakkers JPFA (2009) ProACT for stress urinary incontinence after radical prostatectomy. Urol Int 82:394–398. https://doi.org/10.1159/000218526

    Article  CAS  PubMed  Google Scholar 

  27. Lebret T, Cour F, Benchetrit J et al (2008) Treatment of postprostatectomy stress urinary incontinence using a minimally invasive adjustable continence balloon device, ProACT: results of a preliminary, multicenter, pilot study. Urology 71:256–260. https://doi.org/10.1016/j.urology.2007.08.062

    Article  PubMed  Google Scholar 

  28. Trigo-Rocha F, Gomes CM, Pompeo ACL et al (2006) Prospective study evaluating efficacy and safety of Adjustable Continence Therapy (ProACT) for post radical prostatectomy urinary incontinence. Urology 67:965–969. https://doi.org/10.1016/j.urology.2005.11.011

    Article  PubMed  Google Scholar 

  29. Venturino L, Dalpiaz O, Pummer K, Primus G (2015) Adjustable continence balloons in men: adjustments do not translate into long-term continence. Urology 85:1448–1452. https://doi.org/10.1016/j.urology.2015.01.045

    Article  PubMed  Google Scholar 

  30. Nestler S, Thomas C, Neisius A et al (2019) Long-term results of ProACT primary and repeat implantation for treatment of stress urinary incontinence in men. World J Urol 37:1173–1179. https://doi.org/10.1007/s00345-018-2483-4

    Article  PubMed  Google Scholar 

  31. Yiou R, Butow Z, Baron T et al (2015) Adjustable continence therapy (ProACT™) after male sling failure for patients with post-radical prostatectomy urinary incontinence: a prospective study with 1-year follow-up. World J Urol 33:1331–1336. https://doi.org/10.1007/s00345-014-1447-6

    Article  PubMed  Google Scholar 

  32. Angulo JC, Schönburg S, Giammò A, et al (2019) Systematic review and meta-analysis comparing adjustable transobturator male system (ATOMS) and adjustable continence therapy (ProACT) for male stress incontinence. PLoS One 14:e0225762. https://doi.org/10.1371/journal.pone.0225762

Download references

Funding

The authors declare they have no financial interests.

Author information

Author notes

  1. Thibault Tricard and Qi-Xiang Song have contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Thibault Tricard, Qi-Xiang Song, Jia Yi Li, Jing Leng, Jia Hua Pan & Wei Xue

  2. Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 Place de L’Hôpital, 67000, Strasbourg, France

    Thibault Tricard & Christian Saussine

  3. Centre d’Urologie UROVAR, Avenue Bizet, 83000, Toulon, France

    Pierre Munier

Authors
  1. Thibault Tricard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qi-Xiang Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pierre Munier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jia Yi Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jing Leng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christian Saussine
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jia Hua Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wei Xue
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TT: protocol/project development; literature search; data collection or management; data analysis; manuscript writing/editing. QXS: protocol/project development; data collection or management; data analysis; manuscript writing/editing. PM: Data collection or management; literature search; manuscript editing. JYL: manuscript editing. JL: manuscript editing. CS: manuscript editing. JHP: manuscript editing. WX: protocol/project development; manuscript writing/editing. Authorship principles: All the authors whose names appear on the submission. (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Thibault Tricard.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Consent to participate

No human subjects or participants were required for this project or needed consent.

Consent for publication

All the authors and contributors have issued their consent for submission and publication of the following work.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tricard, T., Song, QX., Munier, P. et al. Adjustable continence therapy (proACT) for the treatment of male stress urinary incontinence post-prostatectomy: a systematic review and meta-analysis (2023 update). World J Urol 41, 1793–1802 (2023). https://doi.org/10.1007/s00345-023-04452-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-023-04452-6

Keywords

Search

Navigation