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

Yiou, R.; Bütow, Zentia; Baron, T.; Salomon, Laurent; Audureau, Étienne

doi:10.1007/s00345-014-1447-6

Cited by 18 publications

(13 citation statements)

References 24 publications

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“…An additional indication for the ProACT therapy in elderly patients, who cannot undergo major surgery or avoid an active system due to a lack of manual dexterity . ProACT can also be implanted in failed sling patients and has shown favorable functional results . More research is needed to determine who may be the best candidates for ProACT as a first‐line therapy vs patients who will likely not benefit as greatly.…”

Section: Discussionmentioning

confidence: 99%

“…19 ProACT can also be implanted in failed sling patients and has shown favorable functional results. 9,25 More research is needed to determine who may be the best candidates for ProACT as a first-line therapy vs patients who will likely not benefit as greatly. However, ProACT should be considered for all patients presenting with SUI that desire surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

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Adjustable continence therapy (ProACT) for the treatment of male stress urinary incontinence: A systematic review and meta‐analysis

Larson

Jhaveri

Yeung

2019

Neurourology and Urodynamics

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Aims First, to evaluate the efficacy of adjustable balloon devices or adjustable continence therapy (ProACT) in the treatment for male stress urinary incontinence (SUI). Second, to investigate the safety profile and rates of adverse events associated with the implantation of adjustable balloon devices. Method A review of the literature was performed by searching the PubMed database with the most applicable search terms. 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 In total, 19 studies were included with a total of 1264 patients and 4517 patient‐years of follow‐up data (mean follow‐up time 3.6 years). ProACT implantation resulted in an incontinence QOL improvement of 30.8 points from baseline. At baseline, patients on average were using 4.0 pads per day (PPD) (95% confidence interval [CI]: 2.6‐5.4), which was reduced to an average of 1.1 PPD (95% CI: 0.5‐1.7) after ProACT implantation. The number of patients that were considered “dry” was 60.2% (95% CI: 54.2%‐65.9%) and the number of patients who were found to be either “dry” or improved greater than 50% was 81.9% (95% CI: 74%‐87.8%). Conclusions Implantation of adjustable balloon devices is efficacious and safe for the treatment of male SUI. Given the minimal invasiveness of the therapy, adjustable balloon devices may be a serious option as a first‐line treatment in nonirradiated patients with SUI who are not ideal candidates for the artificial urinary sphincter.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Adjustable continence therapy (ProACT) for the treatment of male stress urinary incontinence: A systematic review and meta‐analysis

Larson

Jhaveri

Yeung

2019

Neurourology and Urodynamics

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“…Only one publication focuses on PUB after failed slings. 18 In this prospective study that included 20 patients, Yiou et al concluded in favor of ACT as an alternative to sling removal and AUS implantation, with 66.7% patients healed. Our results corroborate their conclusion, with 26 patients improved (96.3%) and 18 healed (66.7%).…”

Section: Discussionmentioning

confidence: 90%

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

Munier

Nicolas

Tricard

et al. 2020

Neurourology and Urodynamics

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Background Stress urinary incontinence (SUI) is a major component of the post radical prostatectomy (RP) trifecta. Surgical treatments are sub‐urethral slings, artificial urinary sphincter (AUS) and adjustable peri‐urethral balloons (PUB) ProACT. All options are imperfect at best and persistent SUI is challenging when AUS is not manageable. Aims This study analyzed the cumulate experience of our 2 centers with offering PUB implantation for SUI post RP in patients with insufficient improvement from slings. Materials & Methods This retrospective study reviewed all patients implanted with second line ProACT. The primary endpoint was continence, defined as 0 pads per day (PPD). The secondary endpoints were 50% decrease in PPD and increases in the Incontinence Quality of Life score (IQOL). Refilling and complications were reported. Results Between 2007 and 2016, 26 patients were implanted. Five patients have had adjuvant radiotherapy (18%). The mean follow‐up was 36 months (±20; min 14‐max 128). All patient presented with persistent SUI, using 2.3 PPD (±1; min 1–max 6), and only one sling was removed due to infection. After ProACT with an average 3 mL refilling (±1.2 min 2–max 6), 18 patients (66.7%) were continent. Eight of the remaining patients (29.6%) were improved; their number of PPD decreased from 2.6 to 1. The average IQOL score of those 8 patients increased by 20 points, from 53.4 up to 74.2 (P = .005). Overall 26 patients (96.3%) were improved. The remaining patient was not implanted because of an intraoperative urethral injury and is considered a failed case (3.7%). He had instead an AUS implantation. Three patients (14.8%) needed PUB replacement. Conclusion The limited population of patients from both our centers who presented with persistent SUI after RP, despite sling placement, improved with PUB ProACT implantations without significant complications.

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“…One study reported that while ProACT device appears to be safe and efficacious in the short term, postoperative readjustment allows for achievement of a short-term continence and in the long-term, the ProACT does not appear to be an ideal device for durable continence and patients’ satisfaction with less than 5% of patient being dry and 45% of patients remained satisfied with ProACT device at median follow-up of 57 months (69). Nonetheless it appears that ProACT device may provide some additional benefits for improving continence in case of persistent incontinence after male sling insertion (70). Common complications of ProACT device include balloon migration, pain, infection and recurrent incontinence.…”

Section: Methodsmentioning

confidence: 99%

Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery

Chung¹

2017

Transl. Androl. Urol.

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Male stress urinary incontinence (SUI) remains a debilitating condition that adversely impacts all domains of quality of life and is associated with significant social stigma and health economic burden. The incidence of post-prostatectomy urinary incontinence (PPI) depends on the definition of urinary incontinence and the length of patient follow up. In patients with persistent PPI following failure of conservative measures, surgical treatment is recommended although there is no published guideline on when surgery should be performed, and what the best surgical option is. Male slings (MS) can be divided into adjustable or non-adjustable types, and offers an attractive option for patients who wish to avoid mechanical handling during urinary voiding. Published intermediate data supports good safety and efficacy rate in men with mild to moderate degree of SUI. The AMS 800 artificial urinary sphincter (AUS) remains the standard of treatment for complete continence and has the longest efficacy and safety records. Other AUS-like devices are designed to address current AMS 800 limitations but themselves are fraught with their own issues.

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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

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

Cited by 18 publications

References 24 publications

Adjustable continence therapy (ProACT) for the treatment of male stress urinary incontinence: A systematic review and meta‐analysis

Adjustable continence therapy (ProACT) for the treatment of male stress urinary incontinence: A systematic review and meta‐analysis

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

Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery

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