Pro-Act substitution for mechanical rupture of the periurethral balloon: Step-by-step surgical education video

Stress urinary incontinence (SUI) is a feared complication after radical prostatectomy because it impacts on the quality of life and determines a high rate of emotional distress (Nash et al., 2018 [1]). When the conservative approach in terms of behavioral, physical (pelvic-floor rehabilitation) and pharmacological treatments fails, a surgical management is usually recommended to treat the post-prostatectomy stress urinary incontinence. The Adjustable Continence Therapy prosthesis (Pro-ACT) is a postoperatively adjustable device that aims to achieve optimal outlet resistance by progressively increasing the volume of the periurethral balloons. Furthermore, in case of mechanical rupture or balloon leakage it can be easily substituted (removed and reimplanted) in centers with experience (Finazzi Agra et al., 2019 [2]). In this video we present the clinical case of a male patient who had undergone PRO-ACT implantation about 10 years ago. Due to the right balloon leakage, its substitution was indicated and performed under ultrasound guidance (Gregori et al., 2010 [3]). The aim of the current manuscript is to provide a description of the surgical technique. The related video shows the technique as a set of simple steps that make the surgical procedure safe and reproducible.