Too old for surgery? Minimally invasive procedure to treat incontinence is still an option

This study examined the safety and effectiveness of ACT balloons in treating stress urinary incontinence in older patients.

The researchers concluded that the ACT balloon procedure may benefit older patients experiencing urinary symptoms due to urethral dysfunction.

Stress urinary incontinence is often caused by weakness of the urethra (urinary tract), also called intrinsic sphincter deficiency or urethral dysfunction. Urethral dysfunction is especially common among men and older women with symptoms of stress urinary incontinence. ACT balloons (short for adjustable continence therapy) have been suggested as a possible treatment option for incontinence due to urethral dysfunction, since ACT balloons are suitable for older patients. ACT balloons are implanted near the bladder, and increase the resistance of the urethra, thereby protecting against accidental urine leakage. 

A total of 52 women, aged 80 or over and with documented urethral dysfunction, were included in this study. All women received minimally invasive ACT balloon surgery. Therapy outcomes were monitored for an average of 10 months.

Overall, the ACT balloon procedure was well-tolerated, and often achieved with only local anesthesia (in 64% of women undergoing treatment). The ACT balloon procedure was also associated with short hospital stays (87% of women were discharged within 24 hours). Complications during the procedure, such as damage to the bladder or urethra, were rare and occurred in only five women. However, ACT balloons were eventually removed in 22 women following late complications (including infection and balloon erosion).

On average, women needed three adjustments of balloon inflation during the course of the study. Seven women (14%) achieved full continence after the first implantation. Another 13 women (25%) reported significant improvements in urinary symptoms (10 women after the first implantation, two after the second and one after the third adjustment). Overall failure rate of the ACT balloon procedure was estimated to be 42%.

The researchers concluded that the ACT balloon procedure is reasonably effective in treating stress urinary incontinence in elderly women, for whom more traditional treatments are no longer an option.

Larger clinical trials are needed to confirm the preliminary results of this study.