Treatment of moderate to severe female stress urinary incontinence with the adjustable continence therapy (ACT) device after failed surgical repair.
BACKGROUND
Treatment of recurrent stress incontinence after a failed surgical procedure is more complicated, and repeat surgeries have higher rates of complications and limited efficacy. We determined the technical feasibility, efficacy, adjustability, and safety of adjustable continence therapy device for treatment of moderate to severe recurrent urinary incontinence after failed surgical procedure.


METHODS
Female patients with moderate to severe recurrent stress urinary incontinence who had at least one prior surgical procedure for incontinence were enrolled. All patients underwent percutaneous placement of adjustable continence therapy (ACT) device (Uromedica, Plymouth, Minnesota). Baseline and regular follow-up tests to determine subjective and objective improvement were performed.


RESULTS
A total of 89 patients have undergone implantation with 1-3 years of follow-up. Data are available on 77 patients at 1 year. Of the patients, 47% were dry at 1 year and 92% improved after 1-year follow-up. Stamey score improved from 2.25 to 0.94 at 1 year (P < 0.001). IQOL questionnaire scores improved from 33.9 to 71.6 at 1 year (P < 0.001). UDI scores reduced from 60.7 to 33.3 (P < 0.001) at 1 year. IIQ scores reduced from 57.0 to 21.6 (P < 0.001) at 1 year. Diary incontinence episodes per day improved from 8.1 to 3.9 (P < 0.001) at 1 year. Diary pads used per day improved from 4.3 to 1.9 (P < 0.001). Explantation was required in 21.7% of patients.


CONCLUSIONS
The ACT device is an effective, simple, safe, and minimally invasive treatment for moderate to severe recurrent female stress urinary incontinence after failed surgical treatment.
Reconstructive and Neurourology, Kaiser Permanente Medical Center, 4900 Sunset Blvd., 2nd Floor, Los Angeles, CA 90027, USA. sherif.r.aboseif@kp.org
Sherif R
SR
Aboseif
Pejvak
P
Sassani
Ethan I
EI
Franke
Steven D
SD
Nash
Joel N
JN
Slutsky
Neil H
NH
Baum
Mai
M
Le Tu
Niall T
NT
Galloway
Peter J
PJ
Pommerville
Suzette E
SE
Sutherland
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004864:Equipment and Supplies / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000628:therapy*; D013520:Urologic Surgical Procedures