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Also known as
Dual Balloon Adjustable Continence Therapy, ProACT
Definition
Dual balloon adjustable continence therapy (DBACT) is a minimally invasive and easily reversible procedure in which two periurethral balloons are placed just distal to the bladder neck to increase bladder outflow resistance. The device is connected to a small titanium port placed under the scrotal or labial skin. The port is used for adjustment to balloon volume in the clinic setting, allowing for refinement and optimization of urinary continence. DBACT placement is typically performed under general anesthesia and is considered an outpatient procedure. Several studies have evaluated the effectiveness of DBACT in treating urinary incontinence, and the results are promising. DBACT was effective in 91% of patients who underwent the procedure, 80% reported a significant improvement in their symptoms, and 70% reported being completely dry after the procedure.¹
Clinical Context
DBACT is indicated for individuals with stress urinary incontinence (SUI) who have not responded to conservative treatments, such as pelvic floor exercises or behavioral changes, or are medically ineligible for other surgical procedures. DBACT may also be an option for individuals who do not want more invasive surgery or are concerned about the side effects of different treatment options. Appropriate candidates for DBACT include patients who have: 1. A diagnosis of Stress Urinary Incontinence. 2. Failed or had inadequate results with conservative treatments. 3. Absence of significant anatomical abnormalities or urethral strictures. 4. Sufficient urethral mobility to accommodate the device. 5. Realistic expectations regarding the benefits and limitations of the procedure. Patients need to discuss their medical history, symptoms, and treatment options with their healthcare provider to determine if DBACT is appropriate. Patients should also undergo urodynamic testing and cystoscopy prior to surgery. It is imperative to rule out bladder neck contraction and to evaluate the urethral anatomy before any invasive treatment. DBACT can be used for both male and female urinary incontinence, although the female ACT system is currently only available in Europe. Patient-specific factors such as medical and surgical history, etiology of stress urinary incontinence, and severity of incontinence can play a role in the effectiveness of DBACT. DBACT has also been shown to be a safe procedure, with few reported complications. The most common complication is mild pain or discomfort at the site of the device placement, which usually resolves within a few days.²