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Also known as
ProACT, Adjustable Continence Therapy, ProACT System, Periurethral Adjustable Balloon Implant, Adjustable Periurethral Balloons, Dual-Balloon Continence Therapy
Definition
Dual-Balloon Adjustable Continence Device Therapy (DBACT) is a minimally invasive treatment for male stress urinary incontinence that utilizes two adjustable silicone balloons implanted bilaterally in the periurethral space just distal to the bladder neck.1 Each balloon is connected via tubing to a titanium port placed subcutaneously in the scrotum, allowing for postoperative volume adjustments without additional surgery.2 The balloons function by increasing bladder outlet resistance through applied pressure to the proximal urethra, which helps prevent involuntary urine leakage during periods of increased abdominal pressure.3 This therapy is primarily indicated for men experiencing stress urinary incontinence following prostate surgery, particularly radical prostatectomy or transurethral resection of the prostate (TURP).4 The adjustable nature of DBACT allows physicians to customize the degree of urethral compression based on individual patient needs, optimizing continence outcomes while minimizing the risk of urinary retention.5
Clinical Context
DBACT is clinically indicated for the treatment of male stress urinary incontinence, particularly in patients who have undergone radical prostatectomy or transurethral resection of the prostate.1 Patient selection criteria include: persistent stress urinary incontinence for at least 12 months after prostate surgery, failure of conservative treatments such as pelvic floor exercises, absence of significant anatomical abnormalities or urethral strictures, and sufficient urethral mobility.2 The surgical procedure is performed under general anesthesia as an outpatient procedure, with two small incisions made to place the balloons on either side of the urethra just distal to the bladder neck, while the ports are placed subcutaneously in the scrotum.3
Postoperative management involves balloon volume adjustments beginning 2-4 weeks after implantation, with incremental changes of 0.5-1.0 cc per side until optimal continence is achieved.4 Clinical outcomes are promising, with studies reporting effectiveness in 85-91% of patients, significant symptom improvement in 80%, and complete dryness in 70% after appropriate adjustments.5 Contraindications include active urinary tract infections, detrusor instability, primarily urge incontinence, residual urine volume greater than 100cc, recent or planned radiotherapy, suspected bladder cancer, untreated bladder stones, and bleeding disorders.2 Complications are generally minor, with the most common being temporary discomfort at the implantation site, while more serious complications such as perforation, migration, erosion, or infection occur less frequently and may require device removal.4