ProACT for Patients

Bladder Control Problems After Prostate Surgery

proact-logoThe external sphincter is a muscle that contracts around the urethra (tube that empties urine from the bladder) and prevents urine from being lost unintentionally. This muscle can be damaged when the prostate is removed or resected, causing occasional, continuous or uncontrolled urine leaks.

If you have had either surgery of the prostate that required a prostatectomy or transurethral resection of the prostate (TURP), you may experience accidental urine leaks when you put pressure on your bladder, such as during a sneeze, cough, or exercise. This condition is called stress urinary incontinence.

You are Not Alone

Men who have undergone radical prostatectomy (RP) for prostate cancer or transurethral resection of the prostate (TURP) are at risk of stress urinary incontinence (SUI). The prevalence of postprostatectomy incontinence (PPI) has ranged from 2% to nearly 60%.   Stress urinary incontinence has a high probability of natural resolution within the first year post-surgery. During this period several therapies, such as pelvic floor training, medication and bulking agents may be helpful in restoring continence sooner, but differences compared with no treatment typically disappear by 12 months post-procedure. Stress incontinence lasting longer than 12 months and/or not responding to conservative treatment may be improved using surgically implanted ProACT devices. Due to its minimally invasive nature, urologists may consider ProACT as a primary therapy if non-surgical methods have not been successful.

How Balloon Therapy Works

The ProACT device consists of two small implantable balloons. During a short outpatient procedure, the balloons are surgically placed under the skin in the area where your prostate was surgically removed or resected. The balloons help protect against accidental leaking of urine by increasing the amount of pressure required to urinate.1 When you need to urinate, a normal amount of bladder effort is still required to push the urine out under a normal process. However, pressure from the balloons will help guard against unintentional urine loss, such as during a sneeze or cough.

The complete ProACT system is implanted within your body and once implanted, no one but you will know it is there. Your doctor can inflate, deflate, or remove the device as necessary at any time after the surgery. There is no need for you to manipulate any part of the device, as would be the case with an artificial urinary sphincter.

Procedure

43The ProACT procedure is minimally invasive and lasts approximately 20 – 30 minutes.2  The procedure will be performed either in the hospital or in the outpatient clinic and you will be given a local or spinal anesthetic.  Using X-ray or ultrasound imaging, two balloon devices will be implanted – one on each side of the bladder neck with two small incisions on either side of the urethra.3 Your surgeon will examine the position of the balloons to ensure correct placement.  The balloons will be inflated with fluid to secure their position.  The titanium ports will lie beneath the surface of the skin.  A urethral catheter will be inserted after surgery which will be removed prior to discharge when you are able to pass urine on your own.

Post-Op Care

Your doctor may prescribe medication such as antibiotics for you to take.  You will need to keep the area where the stitches are located as clean and dry as possible, while the stitches are healing.  If you wear pads, they will need to be changed regularly.  Avoid sex, bicycling, exercise and heavy lifting and other activities for the first 3-4 weeks after the procedure.  Once your stitches are healed and the swelling is gone, you may resume normal activities.

In the first few days after the surgery, you may be completely dry.  However, during the next 2-4 weeks you may leak again after the swelling has disappeared.  This is completely normal and is to be expected.  Your doctor can adjust the fluid levels in the balloons to reduce the leaking.  When an adjustment is needed, a small needle will pass through the skin into the port to add or remove fluid from the balloons.  During the adjustment phase, you should see improvement over your pre-surgery state, but it may take 3-4 adjustments over the course of 3-6 months to achieve the desired effectiveness.

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  1. Utomo E,Groen J,Vroom IH,Mastrigt RV,Blok BFM Urodynamic Effects of Volume-adjustable Balloons for Treatment of Postprostatectomy Urinary Incontinence  Urology. 2013 ;DOI 10.1016/j.urology.2013.01.020 (Epub ahead of print)
  2. Kjaer,L, Fode,M, Norgaard N, Sonksen J and Nordling J Adjustable continence balloons: Clinical results of a new minimally invasive treatment for male urinary incontinence.Scandinavian J of Urology and Nephrology , 2012;1-5 (DOI:10.3109/00365599.2012.660986)
  3. Gregori A, Romano AL, Scieri F, Pietroantuono F, Incarbone GP, Salvaggio A, Granata A, Gaboardi F. Transrectal Ultrasound-Guided Implantation of Adjustable Continence Therapy (ProACT): Surgical Technique and Clinical Results after a Mean Follow-up of 2 years. Euro Urol 2010 Mar; 57(3):430-6.