[Pro-ACT™ device implantation efficiency in second line treatment of post-radical prostatectomy urinary incontinence after sub-urethral male sling failure]

Abstract

Introduction and objectives: The periurethral adjustable balloons (PUAB) Pro-ACT™ are less invasive technique to treat non-severe forms of post-radical prostatectomy urinary incontinence (pRP-UI), like sub-urethral trans-obturator male sling. Few data of efficiency are available for their use in second line treatment after male sling failure.

Objective: To evaluate the efficiency of PUAB Pro-ACT™ (Uromedica, Inc., MN, USA) in the second line treatment for non-severe pRP-UI after male sling failure.

Materials and methods: Single center retrospective study of patients treated with male sling (17 Advance™, 1 TOMS™) between 2009 and 2015. The continence results were evaluated by the number of pad per day and the quality of life assessment by the I-QOL questionnaire. The "cure" was defined as no pad and "improved" as decreased more than 50 % of pads use.

Results: Eighteen patients were included with median follow-up of 21.5 [14-44] months. Two patients (11.1 %) had a past history of pelvic radiotherapy. The median pads per day used was 2 [1-3] after male sling insertion and before Pro-ACT™ device insertion. After Pro-ACT™ device insertion, the median pads per day used was 0 [0-1], with 77.7 % of patients cured and 22.2 % improved. The median quality of life score I-QOL, was 52.2 [23.3-62.6] and 83 [31.8-97.7], respectively before and after Pro-ACT™ device insertion (P<0.001). Nine (60 %) patients rated their incontinence severity as mild, four (26.6 %) as middle and two (13.3 %) as severe, after balloon insertion. The median volume of adjustment was 3 [2-6] mL.

Conclusions: The PUAB Pro-ACT™ have a significant efficiency for use after male sling failure and can be used in second line therapy.

Level of evidence: 3.

Keywords: Adjustable continence therapy Pro-ACT™ device; Ballons péri-urétraux ajustables Pro-ACT™; Bandelettes sous urétrales; I-QOL; Incontinence urinaire masculine; Male urinary incontinence; Prostatectomie radicale; Radical prostatectomy; Sub-urethral sling.