[Adjustable Continence Therapy in women, middle term follow-up and a new technique for balloon positioning].
OBJECTIVE
Evaluation of the results of Adjustable Continence Therapy (ACT) in women by a retrospective one-center study and exposure of a technique: bladder neck retrovision.


METHODS
Between January 2001 and February 2009, 67 women had ACT implantation by the same surgeon for the indication of urinary incontinence by intrinsic sphincter deficiency, with mean age of 70.2 years. Mean follow-up was 24.8 months (1 to 89 months). Evaluation of functional results was realized with the research of urinary leakage when coughing or during abdominal thrust in the clinical exam, with the Urinary Symptom Profile (USP) questionnaire (since 2007), and with an analogical global satisfaction evaluation.


RESULTS
More than 90% of women (n=67) have been improved at least at one medical consultation, and 60% (40/67) at last follow-up with a satisfaction index superior to 80% in 25 patients. Urinary leakage when coughing or doing abdominal thrust disappeared in 58% (36/62). An improvement of USP score was observed in 76% (19/25). Postoperative complications occurred in 37.3% (25 patients) with a mean period of 10.8 months after surgery.


CONCLUSIONS
The ACT, indicated in stress urinary incontinence, is attractive because of the benefit-risk ratio. It could represent an alternative treatment when the artificial urinary sphincter is not technically possible, not accepted or when a reversibility is required. The bladder neck retrovision would improve the ACT surgery by precision and safety.
Vayleux
B
B
Clinique urologique, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France. bertrand.vayleux@yahoo.fr
Luyckx
F
F
Thélu
S
S
Rigaud
J
J
Bouchot
O
O
Karam
G
G
Le Normand
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014521:Urethra; D014549:Urinary Incontinence / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods