Options for treating stress urinary incontinence in women have grown over the years, but one of the most promising is the Adjustable Continence Therapy (ACT) technique by Uromedica.

"I've worked with many technologies that treat urinary incontinence and this one looks good," said Joel N. Slutsky, M.D., F.A.C.S., with Urological Surgeons of Illinois.

ACT is the only post-operatively adjustable treatment for stress urinary incontinence; in essence, after a short outpatient surgery, the device can easily be changed to meet the patient's needs later on.

Riverside and Rush University Medical Center will be one of four trial centers for this treatment nationwide. Dr. Slutsky is an assistant professor of urology at Rush.

For Adjustable Continence Therapy (ACT), adjustable balloon implants are placed on either side of the bladder neck to help maintain normal bladder control. Balloons are post-operatively adjustable through a small port just beneath the skin.

FDA approval is expected for the ACT treatment soon. Then ACT procedures will begin at trial centers.

This month, Dr. Slutsky is scheduled to perform ACT surgeries in Germany, working under the guidance of a urologist who has performed over 100 of them. "In Germany and Italy, the surgeries are already being performed; patient results are positive," Dr. Slutsky said. "We already have patients here who are thinking about having this procedure done," said Dr. Slutsky. Stress urinary incontinence affects millions of women worldwide, causing them to pass urine when they sneeze, laugh, cough, or exercise. The neck of the bladder cannot stay closed and urine is easily expelled. During the ACT treatment, two silicone balloons are implanted bilaterally on either side of the bladder neck to maintain normal bladder control. Balloon volume can be increased or decreased through a subcutaneous port, just under the skin near the urethra opening. Volume of the balloons is changed by inserting a syringe into the ports.

Post-operatively adjustable implants places bilaterally in a periurethral position at the bladder neck maintain uniform coaptation and normal bladder control. The balloons are post-operatively adjustable through a small subcutaneous port.

The Benefits of ACT Include:

• Eliminates the risk of over-treatment or under-treatment
• Larger balloon volume reduces the need for multiple devices
• The balloon is not absorbed by the body and does not migrate
• It does not penetrate the urethral wall
• It does not cause allergic reaction
• It is non-destructive to tissue
• It is a 20-30 minute outpatient procedure with local anesthesia
• There are multiple lengths of ports to meet patient's needs
• There are no fixation sutures or anchors required
• There are no abdominal or vaginal incisions
• It is implanted through a tube
• It can be removed easily
• Women of childbearing age can have the procedure

Target Women to Receive This Therapy Include:

• Ages 18-28, highly fit and experiencing loss of bladder control during physical exertion.
• Ages 25-45, having urine leakage as result of childbearing.
• Ages 45-60, menopausal women who may experience loss of bladder control as result of the physical changes of menopause
• Ages 60 plus, who have involuntary leakage and may have difficulty in self-care

There are three main forms of incontinence and all have different methods of treatment. Those forms are: stress urinary incontinence, overflow incontinence and urge incontinence.

In overflow incontinence, the urethra is narrowed by scar tissue and the bladder cannot empty fully.

In urge incontinence, the brain triggers the urge to urinate, but the bladder has a small amount of urine in it.

Other treatments for urinary incontinence include injectable collagen trials, an artificial urinary sphincter, behavioral/muscle therapy, or wearing urinary incontinence pads.

During sling operations, a strip of muscle tissue from the abdomen is used to support the bladder.

For collagen injections, collagen is injected around the urethra to decrease the size of the bladder neck and stop leakage.

Slutsky has also worked with a Durasphere technique which takes 30 minutes to perform. Durasphere is a bulking agent, carbon beads (the size of sand) in gel, injected into the lining of the urethra, above the sphincter muscles, in three or four locations. It also allows the bladder neck to close enough and stop urine leakage.

Other options to treat incontinence include electrical stimulation, biofeedback, diet changes and InterStim Therapy.

For InterStim Therapy, a lead (wire with electrodes on the tip) electrode is implanted near a nerve located in the lower back (just above the tailbone). This nerve controls the bladder. A neurotransmitter (the size of a stopwatch) is placed under the skin in the buttocks area. Electrical stimulation from the device may eliminate or reduce bladder control symptoms.

In sum, the ACT procedure is easier to perform technically, Slutsky said, and "the patient can go back to work the next day."

Urological Surgeons of Illinois, LTD.