Robot-assisted AMS 800TM artificial urinary sphincter implantation for stress urinary incontinence in women: Description of the transperitoneal posterior surgical technique

Objective: Artificial urinary sphincter (AUS) implantation is indicated for women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) affecting their quality of life. The goal of this study was to give a step-by-step description of the surgical procedure of robot-assisted AUS implantation in women. Patients and surgical procedure: A 72 years-old woman with recurrent SUI was referred to our tertiary center. Clinical and urodynamic investigation revealed an ISD for which a minimally invasive robot-assisted AUS implantation was indicated. The AUS was implanted through a transperitoneal posterior robot-assisted approach. A detailed description of the different surgical steps is provided. The plane between the posterior bladder wall and anterior vaginal wall is dissected. The lateral sides of the bladder are detached from the pelvic wall. A cuff sizer is passed around the bladder neck under vision. An adequate cuff size is chosen and the cuff is placed around the bladder neck. The balloon is placed in the preperitoneal space and the tubing of the cuff and the balloon are pulled through the abdominal wall. The AUS pump is placed in the labia majora at the side of the patient's dominant hand and all tube connections are made. Results: The total operating time was 177 min. No intra- or postoperative complications occurred. The patient was discharged on postoperative day 2 with catheter in place. Spontaneous micturition recovered after removal of the bladder catheter on day 5. The AUS system was activated in the outpatient clinic after 6 weeks. The patient reported no more SUI. Conclusion: Robot-assisted AUS implantation in women is a feasible and effective surgical treatment for selected women with SUI due to ISD.