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. 2020 Jun;39(5):1417-1422. doi: 10.1002/nau.24355. Epub 2020 Apr 6.


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.

Keywords: ProACT; adjustable continence therapy; male sling; radical prostatectomy; stress urinary incontinence.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Balloon Occlusion*
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / therapy*
  • Prostatectomy / adverse effects*
  • Quality of Life
  • Suburethral Slings*
  • Treatment Outcome
  • Urethra / physiopathology
  • Urinary Incontinence / etiology
  • Urinary Incontinence, Stress / etiology*
  • Urinary Incontinence, Stress / psychology
  • Urinary Incontinence, Stress / therapy*
  • Urinary Sphincter, Artificial*