title: Adjustable continence therapy for female urinary incontinence: a minimally invasive option for difficult cases.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Urology and Andrology, Donauspital, Vienna, Austria.
authors.forename: Johann
authors.initials: J
authors.lastname: Wachter
authors.forename: Armin
authors.initials: A
authors.lastname: Henning
authors.forename: Michaela
authors.initials: M
authors.lastname: Roehlich
authors.forename: Martin
authors.initials: M
authors.lastname: Marszalek
authors.forename: Michael
authors.initials: M
authors.lastname: Rauchenwald
authors.forename: Stephan
authors.initials: S
authors.lastname: Madersbacher