Abstract
A peri-urethrally implanted prosthetic, the adjustable continence therapy device (ACT ® ) has been developed for female Intrinsic Sphincter Deficiency (ISD). We aimed to reproduce in cadaveric dissections the recommended ACT placement and determine the exact rela- tionship of this implant to the relevant internal pelvic anatomy and identify the anatomical location of the balloons in order to facilitate consi- stent clinical outcomes. Six hemi-pelves from post menopausal female cadavers were dissected after standardised insertion of 6 ACT balloons which were variously inflated to determine the best initial filling volume and to observe potential damage to the endopelvic fascia or the pelvic floor. Bilateral placement and expansion of the balloons at the posterolateral aspect of the vesico-urethral junction prevents downwards, lateral or posterior displacement. The endo-pelvic fascia forms the roof of the space with the vaginal wall acting as a barrier to movement. The floor is composed of the urogenital membrane which must be pierced by the trocar to permit successful placement. Rapid balloon expansion was associated with rupture of the overlying endopelvic fascia highlighting the importance of the slow expansion recommended by the manufactu- rer. Implantation of the ACT can be safely achieved through a thorough understanding of pelvic anatomy, and by maintaining full thickness between the surgeons' finger and the insertion instrument. Care should be exercised to correctly orientate the insertion instrument, to avoid any unintended trauma to normal structures.
Published Version
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