Adjustable continence therapy (ProACT/ACTTM) with periurethral balloons for treatment of stress urinary incontinence: a narrative review.

Background and objective: First-line surgical management of stress urinary incontinence (SUI) currently involves implantation of an artificial urinary sphincter (AUS) in male patients and midurethral sling in female patients. Still, there is demand for a less invasive treatment option without the need to use a device during voiding. Since its first description in 2005, many clinics have implemented adjustable continence therapy balloons in male (ProACT^TM) and female patients (ACT^TM).

Methods: Publications on the use of ProACT/ACT^TM were reviewed from 2002 until September 2022, focusing on functional and safety outcomes, including predictors of treatment failure and complications.

Key content and findings: Most publications report the use of ProACT^TM in patients after prostate surgery, with approximately 60% experiencing a cure rate and 82% achieving over 50% improvement. Consistent functional outcome assessment in female and neurogenic lower urinary tract dysfunction (NLUTD) patients lacks. Few predictors of treatment failure were described, resulting in an advise to not use the balloons after male pelvic radiation therapy. High revision rates were observed in all patient groups, with balloon defects as one of the most common causes for revision.

Conclusions: Based on the current literature, ProACT^TM is safe and effective in male patients after prostate surgery, but the role of ProACT/ACT^TM in female and NLUTD patients is still unclear. There is need for research of higher level of evidence with uniform outcome assessments. Preferably, ProACT^TM is prospectively compared with AUS in a randomized setting. In addition, development of better-quality balloons should reduce mechanical failure and revision surgeries, resulting in improved functional and patient satisfaction outcomes.