Abstract
Study design
Retrospective cohort study.
Objectives
To assess the effectiveness and complications of treatment for neurogenic stress urinary incontinence (nSUI) by Adjustable Continence Therapy (ACT™ and ProACT™).
Setting
France.
Methods
A retrospective multicentre study of consecutive patients with neurological pathologies treated for nSUI with ACT balloons.
Results
From January 2001 to January 2013, 102 patients were implanted. Mean (SD) age at implantation was 48.4 (16.5) years. Patients were followed-up for a mean 2.7 (2.3) years. After implantation, 5.9% of patients were totally continent, 51.2% had an improvement in symptoms of at least 50% (including 14.6% with improvements of at least 90%), and 48.8% had improvements of < 50%, including 7.3% of treatment failures. Complications occurred in 70 patients (120 balloons): 21 balloon infections, 34 migrations, 18 device failures, 28 urethral erosions and 28 cutaneous erosions. The procedure was ineffective for 35 patients. Twenty patients underwent permanent explantation. The rate of migrations was lower in patients with upper motor neuron lesion than in those with lower motor neuron lesion (p = 0.04).
Conclusions
ACT is a minimally invasive treatment for SUI related to sphincter deficiency. This is one of the first reports in a sample of patients with neurological disorders implanted by multiple surgeons. ACT could be a less invasive, appropriate alternative to artificial urinary sphincters. However, it is associated with frequent local complications which are easy to manage but that should be reduced in this challenging population.
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Author contributions
BPV conceptualized the study. All authors were involved in designed study. LLN, ECK, PD, XG and PG prepared data analyses. YR, BPV and ECK coordinated data analyses and interpretations. YR analysed the data. All authors assisted overall interpretation and contextualization. YR, BPV wrote the first draft of the manuscript. All authors critically reviewed and approved manuscript.
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EC-K has served as consultant for Uromedica. Remaining authors declare that they have no conflict of interest.
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Ronzi, Y., Le Normand, L., Chartier-Kastler, E. et al. Neurogenic stress urinary incontinence: is there a place for Adjustable Continence Therapy (ACT™ and ProACT™, Uromedica, Plymouth, MN, USA)? A retrospective multicenter study. Spinal Cord 57, 388–395 (2019). https://doi.org/10.1038/s41393-018-0219-3
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DOI: https://doi.org/10.1038/s41393-018-0219-3
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