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

Objective: To report the functional outcomes of robot-assisted laparoscopic artificial urinary sphincter (AUS; AMS 800™, American Medical Systems, Minnetonka, MN, USA) implantation and revision in women with stress urinary incontinence (SUI). Patients and Methods: A pilot prospective monocentric study included all consecutive female patients with SUI 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. Intraoperative and early postoperative complications were reported (Clavien–Dindo classification). Continence was defined as no pad usage. Results: A total of 41 patients, median (interquartile range [IQR]) age 67.5 (57–74.7) years were included. In the group of 27 patients undergoing an AUS implantation, one conversion to laparotomy, one bladder neck and one ureteric injury occurred. The AUS was not implanted in the two latest cases. Twelve minor (Clavien–Dindo Grade I–II) early postoperative complications occurring in 10 patients were reported. The median (IQR) follow-up was 19 (11–27) months. 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 insertion. Two major (Clavien–Dindo Grade III–V) early postoperative complications occurred in two 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 (IQR) follow-up was 18 (13.5–24.2) months. The continence rate was 83.3% (10/12 patients). Conclusion: 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.