Techniques – Robotic-assisted laparoscopic implantation of artificial urinary sphincter with concomitant hysterectomy and sacrocolpopexy

Abstract

The artificial urinary sphincter (AUS) was first described by Foley in 1943.1 The current generation model of AMS 800 (American Medical Systems, MN, U.S.) has been implanted since 1982. Indications for implantation of an AUS include post-prostatectomy incontinence, neurogenic bladder dysfunction, intrinsic sphincter deficiency (ISD), and rare congenital causes of incontinence.2 When looking specifically at female non-neurogenic stress urinary incontinence, recent studies demonstrate good long-term functional outcomes from the abdominal approach, with success rates of up to 94.4%.3 Recent advances in minimally invasive surgery have mitigated the risks of abdominal surgery, with the first laparoscopic implantation of AUS published in 2005.4 The introduction of robotic-assisted laparoscopic (RAL) surgery brings distinct benefits of superior visualization, improved dexterity, and minimization of blood loss during deep pelvic dissection.5 Hence, we set out to evaluate the role of robotic assistance in AUS implantation in a neurogenic bladder patient with concomitant surgery for pelvic organ prolapse (POP).