Stress urinary incontinence (SUI) frequently coexists with pelvic organ prolapse (POP). Advanced prolapse may mask SUI, which can also develop de novo after prolapse reduction. Current management is based on standardized clinical evaluation using IUGA/ICS terminology and the POP-Q system, integrated with functional imaging such as transperineal ultrasound and dynamic pelvic floor MRI, including MR defecography when indicated. These tools allow accurate assessment of multicompartment prolapse and urethro-cervical mobility. This study describes a robot-assisted anterior abdomino-vaginal mesh suspension (AAVMS), revisiting a historical abdomino-vaginal mesh concept with modern robotic techniques.
From January 2024 to January 2025, sixteen women aged 55-65 years with anterior compartment POP and symptomatic SUI underwent robot-assisted AAVMS and were followed for 12 months. The primary endpoint was patient-reported resolution of SUI at 12 months. Secondary endpoints included perioperative outcomes, adverse events, POP-Q changes, and patient-reported quality of life (P-QOL) and sexual function (PISQ-12).
Operative time ranged from 50 to 90 min. Urinary catheter removal occurred on postoperative day 3, and discharge on days 8-10. At 6 months, 8/16 patients reported complete continence; this increased to 12/16 at 8 months and 15/16 at 12 months. One patient had persistent SUI. No intraoperative or postoperative complications or mesh-related adverse events were observed.
Robot-assisted AAVMS was feasible and associated with progressive improvement in patient-reported continence over 12 months, with a favorable safety profile. Larger comparative studies with standardized objective endpoints are warranted.
Frontiers in surgery. 2026 May 26*** epublish ***
Paolo Meloni, Sara Izzo, Giacomo Vigliercio, Terenzia Simari, Luciano Izzo, Claudia De Intinis, Silvia Lai, Nicole Asnong, Marcello Molle, Daniela Messineo, Paolo Izzo
Obstetrics and Gynecology Unit, Imperia Hospital, ASL1 Imperiese, Imperia, Italy., Plastic and Reconstructive Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Università Degli Studi Della Campania "L.Vanvitelli", Naples, Italy., Specialist Clinic for Gynecology and Obstetrics, ASL1 Imperiese, Imperia, Italy., Ambulatorio Specialistico Ginecologia Ostetricia, ASL 1 Imperiese, Diano Marina, Italy., "Pietro Valdoni" Department of Surgery, Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy., Department of Translational and Precision Medicine, Nephrology Unit, Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy., Department of Radiological, Oncological, and Anatomical Pathology Sciences, La Sapienza University, Rome, Italy.