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

Abstract

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.

Post-Prostatectomy Urinary Incontinence

“…The ProACT ® (Uromedica, Inc., Plymouth, MN, USA) is a noncircumferential compressive device consisting of two silicone balloons that are implanted by a trocar via two small perineal incisions and are placed under fluoroscopic guidance on each side of the bladder neck, close to the vesicourethral anastomotic site. An outpatient procedure fills the balloons, resulting in mechanical compression of the urethra [102].…”

A narrative review: evaluation and surgical management of persistent and recurrent urinary incontinence after previous surgical treatment

“…The management of SUI incontinence after sling placement is dependent on degree of incontinence, timing of device failure, and patient factors. If only mild incontinence is diagnosed, then consideration can be given to conservative strategies as well as periurethral bulking agents or insertion of the ProACT balloon device, for which there are small observational studies within the literature (17,(33)(34)(35). Otherwise moderate to severe urinary incontinence would be better treated with either repeat sling or insertion of AUS.…”

Standing cough test stratification of moderate male stress urinary incontinence

“…Our study is also limited by the absence of adjustable devices for mild to moderate SUI. The adjustable transobturator male sling (ATOMS), Remeex, ProACT, and ARGUS slings have all demonstrated safety and efficacy (29,30). These adjustable slings may prove to have a greater role in the moderate SUI population; however, additional studies will be needed comparing these devices to AUS and retropubic slings for men with varying degrees of SUI.…”