V10-08: Robot-assisted artificial urinary sphincter implantation in a male for neurogenic stress urinary incontinence.
VideoIntroductions and Objectives
An initial experience with robot-assisted implantation of an artificial urinary sphincter (AUS) is reported in order to demonstrate the feasibility and the safety of this intervention.
A 47-year-old paraplegic male ( after spinal cord injury (D9-D10), ASIA-A) with neurogenic stress urinary incontinence was candidate for implantation of AUS. He experienced stress urinary incontinence secondary to neurogenic intrinsic sphincter deficiency, without detrusor over-activity. A minimal-invasive approach was proposed to the patient. A trans-peritoneal five-port approach was chosen, according to the classical three-arm da Vinci® SI (Intuitive Surgical, Sunnyvale, CA, USA) radical prostatectomy settings. A posterior dissection of the bladder was made with a bilateral dissection of vas deferens and vesiculae seminales. Further dissection laterally and anteriorly (Retzius' space) to the bladder made way for the AUS cuff which was then placed circumferentially around the bladder neck. The reservoir was left intra-abdominally in a lateral vesicular space to the right and the pump was placed in a classic scrotal position (to the left, given that the patient was left-handed and had a smaller testis on this side). Careful dissection of the area without bladder perforation, which would make AUS implantation impossible, is facilitated by the improved ergonomics of the robotic platform in the limited space of the pelvis.
Total operative time: 180 min. Console-time: 140 min. Estimated blood loss: 5ml. Post-operative period: uneventful.
Our experience with this intervention was encouraging and confirmed the safety and feasibility of the procedure as first reported by Chartier-Kastler et al. The technique is time and cost-effective compared to an open AUS implantation at our institution. This procedure can be safely performed using both skills of a surgeon with a extensive experience in robot-assisted radical prostatectomy dissection and those of a surgeon familiar with AUS implantation.