Adjustable continence therapy (ProACT) and bone anchored male sling: Comparison of two new treatments of post prostatectomy incontinence.

OBJECTIVES

To compare the efficacy of two surgical treatments for male urinary stress incontinence: adjustable continence therapy (ProACT) and bone anchored male sling (BAMS).

METHODS

Eighty-four consecutive post radical prostatectomy incontinent patients received ProACT (n = 46) or BAMS (n = 38) implantation by two different operators in two different centres. Eighty of them had a complete follow up. Both groups were prospectively assessed by number of pads per day and a validated questionnaire (UCLA/RAND). Complications rate and mean operating times were compared. All comparisons were analyzed using the t test, Fischer's exact test and chi(2) analysis (significance P < 0.05).

RESULTS

At a mean follow up of 19 and 33 months respectively, 30/44 (68%) patients treated with ProACT were dry (0/1 safety pad) in comparison with 23/36 (64%) patients treated with BAMS (P > 0.05). Stratifying the results, ProACT had 33/39 (85%) dry patients in severe (more than three pads/day) preoperative incontinence, in comparison with 21/26 (81%) for BAMS (P > 0.05). The UCLA/RAND questionnaire showed an average increase of 11.7 points (from 10.2 to 21.9) for ProACT and of 10 points (from 11.9 to 21.9) for BAMS (P > 0.05). Complications included removal of ProACT and BAMS in 6/44 (14%) and 2/36 (6%), respectively. Mean operating time was 18 min and 45 min (P < 0.05) for ProACT and BAMS, respectively.

CONCLUSIONS

ProACT and BAMS are both associated with a satisfactory rate of success. ProACT results seem to be better for severe incontinence and BAMS for mild incontinence. The operation time of ProACT is shorter.