V1-02: Robot Assisted Laparoscopic Placement of Bladder Neck Artificial Urinary Sphincter.
We present our technique of robot assisted laparoscopic placement of bladder neck artificial urethral sphincter (Robot-AUS). Compared to the open approach, the robot assisted laparoscopic technique allows for excellent visualization of the posterior dissection.
Our patient is a 49-year-old male with history of L1 spinal cord injury with stress urinary incontinence between intermittent catheterizations. Using the Da Vinci Xi surgical system, the bladder neck was circumferentially dissected. A 9cm AMS 800 AUS cuff was placed around the bladder neck after confirming appropriate sizing with simultaneous cystourethroscopy. The pressure-regulating balloon was placed in the recreated space of Retzius. Tubing connections were created extracorporeally at the right lower quadrant port site; the pump was passed subcutaneously from this port site to the right hemi-scrotum.
The patient was discharged home on post-operative day #1, performing intermittent catheterization through a deactivated cuff. His stress urinary incontinence persisted until his device was activated at post-op week 4. Six months post-operatively, he is dry without the use of pads and is able to easily pass his catheter after cycling the AUS.
Bladder neck artificial urinary sphincter is effectively placed in a minimally invasive fashion with a robot assisted laparoscopic approach; the approach provides excellent visualization of the posterior dissection. _x000D_