Introduction: The ProACT adjustable continence balloon system is indicated for use in male stress urinary incontinence. ProACT implantation is typically performed using cystoscopic guidance to define the bladder neck, aid in trocar insertion, and guide balloon positioning. However, during prosthetic device placement, repeated entrance and removal of the cystoscope into the urinary tract may increase the risk of wound and device contamination, which may ultimately lead to infection and explantation of the device. Additionally, the control of the cystoscope while passing the trocar is cumbersome without the aid of an assistant to the surgeon. We describe a novel technique for a purely fluoroscopic-guided ProACT placement that maintains sterility throughout the procedure, decreases operative time, and allows for completion without the need for a skilled surgical assistant.
Methods: This video shows a step-by-step execution of ProACT implantation without the use of cystoscopy. We utilize a urethral catheter to perform a cystogram to define the bladder neck and location of the urethra. Real time fluoroscopy is used to guide obturator and trocar placement. Deflection of the trocar assesses proximity and trajectory to the contrast-defined urethra, foley catheter, and bladder neck. Prior to balloon placement, we monitor for egress of urine from the trocar after removal of the obturator, which can signify bladder perforation.
Results: By implementing this new technique, the contamination classification of the case can be categorized as “clean” instead of “clean-contaminated”, making the procedure more consistent with the generally accepted principles for prosthetic device placement. Operative time is reduced by eliminating additional cystoscopic set-up time and eliminates the need for an assistant to perform cystoscopy.
Conclusions: The purpose of this video is to demonstrate the feasibility and benefits of a novel approach for ProACT implantation without the use of cystoscopy. Forgoing cystoscopy converts this surgical procedure from “clean-contaminated” to “clean”. Additionally, this technique modification decreases operative time and allows for the procedure to be easily done by a single surgeon. Future studies should be aimed at comparing outcomes using this newly described technique as compared to the standard cystoscopic guided approach.
Source of Funding: No funding was received for the creation of this video.