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Robot‐assisted laparoscopic artificial urinary sphincter insertion in women with stress urinary incontinence: a pilot single‐centre study
Author(s) -
ChartierKastler Emmanuel,
Vaessen Christophe,
Rouprêt Morgan,
Bassi Silvia,
Cancrini Fabiana,
Phé Veronique
Publication year - 2020
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.15147
Subject(s) - medicine , surgery , urinary incontinence , interquartile range , laparotomy , neck of urinary bladder , urinary system , dissection (medical) , urinary bladder
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.