# Flexible cystoscopy‐guided implantation of ProACT: Surgical technique and long‐term outcomes

## TL;DR

Flexible cystoscopy-guided ProACT implantation is a safe and effective long-term treatment for men with urinary incontinence after prostate cancer surgery.

## Contribution

A novel surgical technique using flexible cystoscopy for ProACT implantation is described with long-term clinical outcomes reported.

## Key findings

- 64% of patients retained the balloon at last follow-up.
- Success and improvement rates were 62% and 17%, respectively.
- Perioperative complications occurred in 5% of cases, with device deflation being the most common long-term issue.

## Abstract

We aim to describe the ProACT implantation using flexible cystoscopic guidance and to report long‐term outcomes in these patients.

This single‐centre retrospective study include all men who underwent ProACT™ for SUI after RP using flexible cystoscopic guidance between 2007 and 2021. The implantation was performed via a perineal approach under general or locoregional anaesthesia. Accurate positioning was ensured using both real‐time fluoroscopic and endoscopic guidance (flexible cystoscopy retroflexed toward the bladder neck).

In total, 196 men were included; 18% (n = 36) had previously undergone radiotherapy and 24% (n = 46) had undergone SUI surgery. The median (IQR) follow‐up time was 63 (24–108) months. At the last follow‐up, 64% of participants still had their balloon in place, and the success and improvement rates were 62% and 17%, respectively. The perioperative complication rate was 5% (mainly bladder injury and acute urinary retention). Forty‐two per cent (n = 82) experienced at least one complication, mainly device deflation (28%). Definitive explantation occurred in 36% (n = 71), with secondary implantation of an artificial urinary sphincter in 96% (n = 68).

ProACT® adjustable balloon implantation using flexible cystoscopic guidance appears to be an effective and safe long‐term procedure for men with SUI after RP.