Robot-assisted AMS-800 Artificial Urinary Sphincter Bladder Neck Implantation in Female Patients with Stress Urinary Incontinence

BACKGROUND:

Widespread adoption of the AMS-800 artificial urinary sphincter (AUS) in female patients has been hampered by the surgical morbidity of its implantation through an open approach.

OBJECTIVE:

To describe a standardized technique of robotic bladder neck AUS implantation in female patients, and to report the perioperative and functional outcomes obtained by multiple surgeons with this technique.

DESIGN, SETTINGS, AND PARTICIPANTS:

We retrospectively reviewed the charts of all female patients who underwent robotic AUS implantation for urinary incontinence due to intrinsic sphincter deficiency between March 2012 and March 2017 in five institutions. Most of the 10 surgeons involved were not highly experienced in female AUS implantation and/or in robotic surgery.

SURGICAL PROCEDURE:

The AUS is implanted at the bladder neck through a transperitoneal robotic approach. The finger placed by the assistant surgeon in the vagina is paramount to expose the vesicovaginal space and guide the robotic surgeon throughout the bladder neck dissection.

MEASUREMENTS:

The primary endpoint was the incontinence categorized as complete continence(ie, no pads used), improved incontinence, or unchanged incontinence.

RESULTS AND LIMITATIONS:

Forty-nine female patients underwent a robotic AUS implantation. There were eight intraoperative complications (16.3%): five bladder neck injuries and three vaginal injuries. Nine patients experienced postoperative complications (18.3%), but only two were Clavien ≥3 (4.1%). After a median follow-up of 18.5 mo, one explantation (vaginal erosion, 2.1%) and three revisions (one mechanical and two nonmechanical failure, 6.1%) were needed. At last follow-up, 40 patients were fully continent (81.6%), six had improved incontinence (12.2%), and three had unchanged incontinence (6.1%).

CONCLUSIONS:

In this first multicenter series of robot-assisted AUS implantation, our technique appeared feasible, safe, and reproducible with perioperative and functional outcomes in the early learning curve not inferior to those reported in large series of open AUS implantation from tertiary referral centers.

PATIENT SUMMARY:

Robot-assisted bladder neck AMS-800 artificial urinary sphincter implantation in female patients with stress urinary incontinence resulting from intrinsic sphincter deficiency is feasible, safe, and reproducible with promising outcomes.