Adjustable Continence Balloons in Men: Adjustments Do Not Translate Into Long-term Continence

ObjectiveTo evaluate the functional results, morbidity, and quality of life of the adjustable continence balloons ProACT for the treatment of male stress urinary incontinence after prostate surgery considering both short- and long-term results.MethodsBetween 2002 and 2012, twenty-two consecutive male patients were implanted with the ProACT device. Continence was defined by the use of 0 pads daily, and the quality of life was assessed by validated questionnaires.ResultsOnly 1 patient (4.5%) was immediately continent after ProACT implantation, and the other 21 men (95.5%) needed ≥1 balloon refillments postoperatively. The baseline daily pad number decreased from a mean of 5.9 pads (range, 3-12 pads) to a mean of 1.7 pads (range, 0-5 pads) per day after refilling but increased to a mean of 3.9 (range, 0-10) at the last follow-up visit. After balloon adjustments, 4 patients (18%) were continent and 18 patients (82%) showed an improvement with a 95% rate of subjective satisfaction. Revision and explantation rates were 73% and 55%, respectively. At a median follow-up of 57 months, only 1 patient (4.5%) remained dry, and only 10 patients (45%) remained satisfied with the procedure, whereas 12 patients (55%) were unchanged and dissatisfied.ConclusionThe ProACT device appears to be safe and efficacious in the short term. The postoperative readjustment allows the achievement of a short-term continence status. However, on the long term, the ProACT does not appear to be an ideal device for durable continence and patients' satisfaction.