Robotic-assisted implantation of an artificial urinary sphincter (AMS-800™) via posterior approach to the bladder neck in women with intrinsic sphincter deficiency step-by-step.

To describe a new technique for robot-assisted AMS-800 artificial urinary sphincter bladder neck implantation in female patients.

We reviewed the medical files of patients who underwent robot-assisted artificial urinary sphincter (R-AUS) implantation from March 2017 to November 2018 at our centre. All of the implantations were performed by posterior approach to the bladder neck in order to avoid blind dissection with the risk of vaginal and/or bladder injury. This strategy was viewed as an alternative to the anterior robot-assisted implantation recently described. Sphincters were activated 5 weeks after implantation. Patients were followed up at 3, 6, and 12 months, then annually.

Eight patients with a median age of 64 years had an R-AUS via posterior approach to the bladder neck. The preoperative pad weight test was a median of 300/gr/24h. Median operative time was 244 minutes. No peroperative vaginal and or bladder injuries were observed. At a median of 12 months of follow-up, all of the AUS were functional. Five patients required no protection (62.5%), 3 had day protection (37.5%), and all of them said they were satisfied except for one patient (12.5%) who requested treatment for persistent urge incontinence.

Robot-assisted artificial urinary sphincter (R-AUS) implantation in women via posterior approach to the bladder neck is a procedure that is simple, reproducible and safe. The short-term functional results are satisfactory and comparable to those via open approach. A more long-term comparison of the efficacy and longevity of AUS implanted by this posterior approach is needed to confirm its interest compared with the anterior robot-assisted approach and the classic open technique. This article is protected by copyright. All rights reserved.

BJU international. 2019 Jul 31 [Epub ahead of print]

Bastien Gondran-Tellier, Romain Boissier, Michael Baboudjian, Mathieu Rouy, Sarah Gaillet, Eric Lechevallier, Floriane Michel, Gilles Karsenty

Aix Marseille University, Urology and Kidney Transplantation department, La Conception Hospital, 147 boulevard Baille, 13005, Marseille, France.