The adjustable continence therapy (ACT®) device has been developed for the treatment of intrinsic sphincter deficiency (ISD) using a standardised surgical technique to optimise continence efficacy. This study examined the extent of structural disruptions caused by its insertion and the possible impact of this device on female sexual anatomy. Bilateral balloon placement was performed in a female cadaver and dissection was used to determine the effect on sexual structures. The pelves were dissected layer-by-layer to examine the structures transversed by the ACT® system, particularly the clitoral tissue, adjacent neurovascular bundles, and its position in relation of the urethra, bladder neck, urogenital diaphragm and endopelvic fascia. The trocar track was observed to have coursed through a relatively “safe” zone between the bulb of the clitoris medially, the crus and clitoral neurovascular bundle anterolaterally and the perineal branches of the pudendal neurovascular bundle posteriorly. The trocar pierced the urogenital diaphragm reaching the desired position between the pelvic diaphragm and the endopelvic fascia, posterolateral to the vesicourethral junction. This method of trocar introduction caused no significant disruption of the clitoris or its neurovascular bundles in the specimens studied. Periurethral implantation of balloon devices may be safely achieved. Insertion of the ACT® trocar device in the location, direction and depth described here did not damage the clitoris or its neurovascular supply. These observations may also be of relevance to other anti-incontinence surgeries that involve instrumentation and insertion of materials beneath or by the side of the urethra.
Corresponding Author: O’CONNELL H.|