The Division of Urology within the University of Colorado Anschutz Department of Surgery has become a national leader in urinary incontinence therapy under the direction of Brian J. Flynn, MD, professor of urology and director of functional and reconstructive urology (FRU).
Flynn recently presented at the annual meeting of the American Urological Association (AUA) on his experiences with Prostate Adjustable Continence Therapy (ProACT), an FDA-approved device to treat urinary incontinence in men. The ProACT system consists of two small adjustable balloons positioned next to the urethra. The balloons are filled with fluid and gently squeeze the urethra to help prevent urine leakage. They can be adjusted later by adding or removing fluid without another major surgery.
One of Flynn’s AUA presentations covered his research on using ProACT as salvage therapy for men who failed another incontinence device known as a sling. His analysis of the data found that ProACT is safe and effective in this setting.
Flynn also presented on a technique he developed that uses lateral fluoroscopy imaging in conjunction with anterior-posterior fluoroscopy to create a real-time, 3-D image that helps surgeons more accurately position the device. The process has resulted in reduced revision rates and improved initial cure.
“We're the first group to ever do this,” Flynn says. “The manufacturer recommended the anterior-posterior view only, but there was never a physician champion to further develop this procedure. We took our results and broke them down into four quartiles, and we saw our results improving in each quartile. When we tried to figure out why that was, we realized the adoption of the lateral view allows more precise needle localization and precision for balloon placement.”
The Division of Urology at CU has now performed over 400 ProACT implants, more than any other center in the world, Flynn says, and is beginning to get referrals from other centers.
“We are seeing patients from around the country,” he says. “It's not uncommon we get referrals from MD Anderson and other sites, because we're ahead of everyone else on the technique as we've gone through the learning curve. We're starting to accelerate now, and this has become a big part of our practice, and how we treat men with incontinence.”
Flynn and his FRU team are working with the Surgical Outcomes and Applied Research (SOAR) program in the Department of Surgery to create a staging system for men with incontinence that will indicate the best device or procedure for each individual situation. That could include ProACT, the sling device, or the artificial urinary sphincter.
“Our researchers Helen Sun, MD, and Alex Malhotra, MD, are working to find out where the ProACT device performs the best and why, and we're coming up with a grading system — grades one, two, and three — in terms of the patients,” he says. “This is done in cancer, and most people realize it's easier to cure a stage I cancer patient than a stage IV. We want to do something similar in incontinence. We can cure almost all of our grade one patients, most of the grade two, and some of the grade three. We want to put that into the calculator that SOAR is helping us develop and then bring that to other centers, so we can match the right therapy with the right patient.”