Adjustable continence therapy for female urinary incontinence: a minimally invasive option for difficult cases

Abstract

Aim: To assess the role of Adjustable Continence Therapy (ACT) as a minimally invasive treatment for women with urinary incontinence (UI) after failed previous incontinence surgery or when conventional surgical treatment was considered problematic.

Material and methods: The ACT device consists of two balloons implanted at the level of the bladder neck using a paraurethral/vaginal approach with the aim of coapting the urethra. Balloon filling can be adjusted postoperatively via a port placed in the labia majora.

Results: 41 women with a mean age of 73 (range 42-93) years were evaluated. 15 (38%) women had failed previous UI surgery with 83% having undergone prior pelvic surgery. Mean follow-up was 25 (5-60) months. Adjustment of the ACT balloons was necessary in 28 women (69%). Overall, 44% of women became fully continent, 15% reported a significant improvement of UI, a further 29% had a slight improvement, while 12% indicated no change. ACT-related complications occurred in 16 (39%) patients, including balloon migration, transient urinary obstruction and balloon leakage.

Conclusions: ACT is an attractive minimally invasive option for women with UI with previous failed incontinence surgery or when conventional incontinence surgery carries a high risk of failure.