Initial experience with ACT™ periurethral adjustable balloons to treat urinary incontinence due to intrinsic sphincter deficiency in the pediatric population

• Published in: World journal of urology 2023-10, Vol.41 (10), p.2767-2774
• Main Authors: Faure, Alice, Haddad, Mirna, Pinol, Jessica, Merrot, Thierry, Guys, Jean-Michel, Michel, Floriane, Karsenty, Gilles
• Format: Article
• Language: English
• Subjects: Adolescent; Balloon treatment; Child; Child, Preschool; Children; Congenital defects; Female; Humans; Invasiveness; Male; Medicine; Medicine & Public Health; Nephrology; Neural tube defects; Oncology; Original Article; Patients; Pediatrics; Pilot Projects; Prospective Studies; Prostheses and Implants; Sphincter; Spinal cord; Treatment Outcome; Urethral Diseases; Urinary incontinence; Urinary Incontinence - etiology; Urinary Incontinence - therapy; Urinary Incontinence, Stress - surgery; Urinary tract; Urology
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-023-04550-5

Purpose To present our initial experience with periurethral adjustable continence therapy (ACT™) for urinary incontinence due to intrinsic sphincter deficiency (ISD) in children. Methods This is an approved prospective non-randomized pilot study (NCT03351634) aiming to treat children born with spinal dysraphism (SD) or exstrophy epispadias complex (EEC) with ACT™. Endpoints were patient-reported changes in daily pad count, 24-h Pad test and complications. Results Since April 2018, 13 children (six girls, seven boys) were implanted at the median age of 12 years (5–16). The etiology of incontinence was neurogenic ISD (7/13, 54%) and EEC (6/13, 46%). After ACT™ implantation, continence (no pad or 1 security pad/day) was achieved in 9(69%) patients (5/7 SD, 4/6 EEC). Additionally, two (15%) patients had a significant improvement (decreasing Pad test from 1049 to 310 g at 3 months). One patient (7%) had no improvement. Results were stable at 21 months (6–43) of follow-up. Mean final balloon volume was 2.89 ml (± 0.85) with a median of 3 fillings to obtain continence. We had four revisions due to cutaneous port erosion ( n  = 3) and balloon migration ( n  = 1) and two definitive explantations. PinQ score was significantly improved (47 vs 40.5 with balloon, p  = ns). Neither degradation of the upper urinary tract nor cystomanometric changes have been observed at 6 and 12 months postoperatively. Conclusion Urinary incontinence due to ISD owing to EEC or SD can be successfully treated with ACT™ periurethral balloons. Given the minimal invasiveness of this therapy, it might be a first‐line option treatment in children with complex stress urinary incontinence.