Adjustable Continence Therapy After Prostatectomy

The ProACT adjustable continence therapy device is a minimally invasive urologic implant designed to treat male patients who have stress urinary incontinence arising from intrinsic sphincter deficiency, following radical prostatectomy for prostate cancer or transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). Since median time to regain continence after radical prostatectomy is around three months, the ProACT is recommended for consideration if a patient still leaks after six months.

The placement procedure involves the insertion of two balloons periurethrally, one on each side of the urethra just beneath the bladder neck to increase its resistance. The device is placed perineally after puncturing of the pelvic floor and developing a space with blunt dissection and fluoroscopic guidance to place the contrast-media filled balloons. A unique feature of the device is the ability to adjust the tightness of the urethral occlusion by altering the amount of fluid in each balloon via a titanium port connector, accessed through a percutaneous injection in the scrotum. Adjustments to fluid content are done in an outpatient setting, usually during the first six months after placement. The ProACT is available in two lengths, 12 cm and 14 cm.

The ProACT is the product of Uromedica (Plymouth, MN, USA) and is currently available in Europe, Canada, and Australia.

Post radical prostatectomy urinary incontinence represents a serious complication of prostatectomy, significantly compromising a patient's quality of life. About 6% of patients undergoing radical prostatectomy will need surgical treatment for their incontinence, with current options including injectable bulking agents, sling procedures, and an artificial urinary sphincter.



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