Robot-assisted laparoscopic artificial urinary sphincter insertion in women with stress urinary incontinence: a pilot single-center study.

To report the functional outcomes of robot-assisted laparoscopic artificial urinary sphincter (AUS, AMS 800TM ) implantation and revision in women with stress urinary incontinence.

A pilot prospective monocentric study included all consecutive female patients suffering from stress urinary incontinence and undergoing an AUS surgery (implantation or revision) using a robotic approach between 2012 and 2018. The AUS was implanted through a transperitoneal robotic approach. The dissection of the bladder neck was initiated using a posterior approach with a permanent visual control. Intra and early postoperative complications were reported (Clavien's classification). Continence was defined as no pad usage.

A total of 41 patients, median age 67.5 years (IQR 57-74.7) were included. In the group of 27 patients undergoing an AUS implantation, one conversion to laparotomy, one bladder neck and one ureteral injury occurred. The AUS was not implanted in the 2 latest cases. Twelve minor (Clavien I-II) early postoperative complications occurring in 10 patients were reported. The median follow-up was 19 months (IQR 11-27). The continence rate was 84% (21/25 patients). In the group of 14 patients undergoing an AUS revision, no vaginal or bladder injury was reported. One patient had a bowel injury with conversion to laparotomy without AUS implantation. Two major (III-V) early postoperative complications occurred in 2 patients: one intraoperative bowel injury, which ultimately resulted in the death of the patient and one device infection requiring an explantation of the AUS. The median follow-up was 18 months (IQR 13.5-24.2). The continence rate was 83.3% (10/12 patients).

The results obtained after robot-assisted laparoscopic AUS implantation among women are promising despite the significant morbidity due to previous pelvic surgeries. Longer follow-up studies are needed.

BJU international. 2020 Jun 19 [Epub ahead of print]

Emmanuel Chartier-Kastler, Christophe Vaessen, Morgan Rouprêt, Silvia Bassi, Fabiana Cancrini, Veronique Phé

Sorbonne Université, Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.