Experience of 5 years adjustable continence therapy (ProACT): the surgical learning curve and patient outcomes

Category	Detail
Condition	Postprostatectomy incontinence (PPI), primarily stress urinary incontinence (SUI)
Key Mechanisms	Adjustable silicon balloons implanted percutaneously apply pressure to urethra and bladder neck to increase urethral resistance
Target Population	Men with persistent PPI after radical prostatectomy or TURP, especially those with impaired hand function
Care Setting	Specialized urology centers with trained surgeons; outpatient follow-up for balloon volume adjustments

ProACT implantation is minimally invasive and less technically demanding for patients compared to artificial urinary sphincter (AUS).
Surgical success rate of ProACT is approximately 53% (0–1 pad/day), with a 31% overall complication rate including 27% explantation.
Learning curve impacts complication and revision rates; surgeon experience reduces adverse outcomes.

Confirm persistent PPI after conservative treatment failure using pad counts and 24-hour pad weight tests.
Classify severity of incontinence (mild to severe) based on pad use (>5 pads/day or >400 g/day).

Consider ProACT implantation for patients with PPI who have failed pelvic floor muscle therapy.
Implant two silicon balloons percutaneously on either side of the urethra cranial to the pelvic floor under general anesthesia.
Adjust balloon volume postoperatively via subcutaneous titanium ports to optimize continence effect.

Assess continence at first follow-up after final balloon adjustment using pad counts, 24-hour pad weight, and patient-reported improvement.
Monitor for complications within six months post-surgery using Clavien-Dindo classification.
Regular outpatient visits for balloon volume adjustments until optimal continence achieved.

Complication rate approximately 31%, including infection and device explantation (27%).
Technical challenges during implantation may increase early complication and revision rates.
Device failure or infection may necessitate removal in outpatient setting.

Men with persistent PPI post-radical prostatectomy or TURP, including those with impaired hand function.

ProACT offers a less invasive alternative to AUS with similar efficacy and fewer complications; requires no patient manipulation during voiding.

Ensure surgeon training and experience to reduce complication and revision rates; supervised initial procedures recommended.
Use objective measures (pads/day, 24-hour pad weight) and patient-reported outcomes to evaluate treatment success.
Schedule regular follow-up visits for balloon volume adjustments to achieve optimal continence.
Consider patient hand function and operability when selecting ProACT over AUS.
Promptly address complications and consider outpatient device removal if necessary.

Clinical Scorecard: Five-Year Outcomes and Learning Curve of Adjustable Continence Therapy (ProACT) in Managing Postprostatectomy Incontinence