Treatment of neurogenic stress urinary incontinence using an adjustable continence device: 4-year followup.
OBJECTIVE
We evaluated the long-term safety and efficacy of an adjustable continence device (ACT® or ProACT™) in male and female patients with neurogenic stress urinary incontinence.


METHODS
Data on patients consecutively treated with implantation of an adjustable continence device due to neurogenic stress urinary incontinence were reviewed from the start of our experience to the current 4-year followup.


RESULTS
We reviewed data on 13 male and 24 female patients with neurogenic stress urinary incontinence due to different forms of pelvic nerve or spinal cord lesions. Mean ± SD age at implantation was 46.2 ± 17.4 years. Of the patients 92% performed clean intermittent self-catheterization. The device was implanted bilaterally using general and local anesthesia in 16.2% and 83.8% of cases, respectively. From before implantation to 48-month followup the mean number of urinary incontinence episodes decreased from 6.1 ± 2.4 to 2.8 ± 3.1 and the mean number of pads used per 24 hours decreased from 4.2 ± 2.7 to 2.2 ± 2.2. Of the patients 54.5% indicated more than 50% improvement of stress urinary incontinence symptoms after 48 months, of whom 38.9% indicated complete continence. Adverse events included erosion/migration, device infection or failure, implantation site pain, bladder stone formation and difficult clean intermittent self-catheterization.


CONCLUSIONS
Implantation of the ProACT/ACT device in patients with neurogenic stress urinary incontinence is minimally invasive and safe. It can significantly improve neurogenic stress urinary incontinence in the long term. Thus, it might be a reasonable option for patients who are not willing, not suitable or not yet ready for more invasive surgery, such as artificial urinary sphincter or fascial suspension sling placement.
Department of Urology and Renal Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris VI, Paris, France.
Ulrich
U
Mehnert
Laurence
L
Bastien
Pierre
P
Denys
Vincent
V
Cardot
Alexia
A
Even-Schneider
Serdar
S
Kocer
Emmanuel
E
Chartier-Kastler
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications; D012189:Retrospective Studies; D013997:Time Factors; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation; D055815:Young Adult