OBJECTIVES: The Adjustable Continence Therapy (ACT®) is a minimally invasive treatment for females with Stress Urinary Incontinence resulting from Intrinsic Sphincter deficiency (ISD) with or without bladder hypermobility. This study represents six year follow up of our first series of patients. MATERIALS AND METHODS: The ACT® device consists of two silicone balloons sited on either side of the proximal urethra under the bladder neck, each attached to a titanium port buried in the labia allowing post operative titration of the balloons. The bilateral balloon placement allows for stabilisation of the bladder neck and enhances urethral resistance. Female patients who had failed previous pelvic surgery underwent Urodynamic assessment; daily pad usage and Incontinence Quality of Life (I-QoL) questionnaire measures prior to implantation of ACT balloons and evaluated post operatively at 1, 3, 6 and 12 months then annually thereafter. Patients were also asked to record their overall impression and percentage of improvement post operatively based on the Patient Global Impression Index (PGI) and Visual Analogue Score (VAS). In addition, complications were recorded. RESULTS: Fifty seven females (mean age 67.2 years) have undergone ACT implantation. Mean follow up is 55 months (range 12–72 months). At last follow-up, mean pad usage improved from 5.6 at baseline to 0.41 and IQOL improved from 27.2–78.6 with 68% patients completely dry based on VAS. Global assessment indicated 17.2% were significantly improved, and 16.9% remained unchanged. Postoperative complications necessitating device removal included migration seen in 7% patients and urethral erosion in 3.5% patients. Additionally, 5 balloons were explanted due to device failure. In total, 12 balloons were removed in 10 patients with only 3 patients requiring bilateral removal performed in the outpatient department. Five patients underwent replacement of their devices with 2 becoming dry (pad free) 2 becoming significantly improved (<1 pad per day) and 1 remaining unchanged CONCLUSION: The relative ease of insertion and the ability to tailor this therapy to an individual patient's needs makes this a very attractive option for the challenging treatment of recurrent stress urinary incontinence due to ISD. Device removal is simple and possible without retention of any foreign body material.