Purpose: To describe a new geometrical stepper-guided navigation system for positioning ProACT®. Methods: The sizing of the stepper-guided navigation system was calculated using the distance from the ideal position of the device to anatomic referral points previously measured by ultrasound. The trocar and subsequently the device were maneuvered to the ideal position in accordance with the navigation system. Measurements: Treatment efficacy was evaluated with daily pad count, 1-hour pad test, Incontinence Quality of Life questionnaire (IQoL), visual analog scale and overall impression. Complications, balloon volume and number of adjustments were reported at 1, 3, 6 and 12 months follow-up visits. Results: Mean follow-up was 12 (range 3–19) months. Daily pad count showed 30 patients (71%) dry and 9 patients (21%) improved. 1 hour pad test showed 28 patients were dry (66%) and 11 patients improved (26%). IQoL increased from an average of 35.3 to 80. Average visual analog scale score was 8. Complications requiring device removal occurred in 3 patients (7%). Mean balloon volume was 3.1 ml. Conclusions: The stepper-guided navigation system to implant ProACT is feasible and extremely reproducible making this procedure more standardized.

1.
Augustin H, Pummer K, Daghofer F, Habermann H, Primus G, Hubmer G: Patient self-reporting questionnaire on urological morbidity and bother after radical retropubic prostatectomy. Eur Urol 2002;42:112–117.
2.
Burkhard FC, Kessler TM, Fleischmann A, Thalmann GN, Schumacher M, Studer UE: Nerve-sparing open radical retropubic prostatectomy – does it have an impact on urinary continence? J Urol 2006;176:189–195.
3.
Penson DF, McLerran D, Feng Z, et al: Five-year urinary and sexual outcomes after radical prostatectomy: results from the prostate cancer outcomes study. J Urol 2005;173:1701–1705.
4.
Rudy DC, Woodside JR, Crawford ED: Urodynamic evaluation of incontinence in patients undergoing modified Campbell radical retropubic prostatectomy: a prospective study. J Urol 1984;132:708–712.
5.
Hammerer P, Huland H: Urodynamic evaluation of changes in urinary control after radical retropubic prostatectomy. J Urol 1997;157:233–236.
6.
Walsh PC, Partin AW, Epstein JI: Cancer control and QoL following anatomical radical retropubic prostatectomy: results at 10 years. J Urol 1994;152:1831–1836.
7.
Hubner WA, Schlarp OM: Treatment of incontinence after prostatectomy using a new minimally invasive device: adjustable continence therapy. BJU Int 2005;96:587–594.
8.
Trigo-Rocha F, Gomes CM, Pompeo AC, Lucon AM, Arap S: Prospective study evaluating efficacy and safety of adjustable continence therapy (ProACT) for post radical prostatectomy urinary incontinence. Urology 2006;67:965–969.
9.
Kocjancic E, Crivellaro S, Ranzoni S, Bonvini D, Gontero P, Frea B: Adjustable continence therapy for the treatment of male stress urinary incontinence: a single-centre study. Scand J Urol Nephrol 2007;41:324–328.
10.
Lebret T, Cour F, Benchetrit J, et al: Treatment of postprostatectomy stress urinary incontinence using a minimally invasive adjustable continence balloon device, ProACT: results of a preliminary, multicenter, pilot study. Urology 2008;71:256–260.
11.
Gilling PJ, Bell DF, Wilson LC, Westenberg AM, Reuther R, Fraundorfer MR: An adjustable continence therapy device for treating incontinence after prostatectomy: a minimum 2-year follow-up. BJU Int 2008;102:1426–1430.
12.
Gregori A, Simonato A, Lissiani A, Scieri F, Rossi R, Gaboardi F: Transrectal ultrasound guided implantation of the ProACT adjustable continence therapy system in patients with post-radical prostatectomy stress urinary incontinence: a pilot study. J Urol 2006;176:2109–2113.
13.
Abrams P, Cardozo L, Fall M, et al: The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003;61:37–49.
14.
Wagner TH, Patrick DL, Bavendam TG, Martin ML, Buesching DP: Quality of life of persons with urinary incontinence: development of a new measure. Urology 1996;47:67–71.
15.
Giammò A, Bodo G, Castellano S, Borrè A, Carone R: Spiral multidetector computerized tomography evaluation of adjustable continence therapy implants. J Urol 2010;183:1921–1926.
16.
Gregori A, Romanò AL, Scieri F, Pietrantuono 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. Eur Urol 2010;57:430–436.
17.
Rajpurkar AD, Onur R, Singla A: Patient satisfaction and clinical efficacy of the new perineal bone-anchored male sling. Eur Urol 2005;47:237–242.
18.
Fischer MC, Huckabay C, Nitti VW: The male perineal sling: assessment and prediction of outcome. J Urol 2007;177:1414–1418.
19.
Rehder P, Gozzi C: Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy. Eur Urol 2007;52:860–866.
20.
Elliott DS, Barrett DM: Mayo Clinic long-term analysis of the functional durability of the AMS 800 artificial urinary sphincter: a review of 323 cases. J Urol 1998;159:1206–1208.
21.
Raj GV, Peterson AC, Toh KL, Webster GD: Outcomes following revisions and secondary implantation of the artificial urinary sphincter. J Urol 2005;173:1242–1245.
22.
Lai HH, Hsu EI, Teh BS, Butler EB, Boone TB: 13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol 2007;177:1021–1025.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.