V11-07: Robot-assisted AMS 800®- sphincter implantation around the membranous urethra in spina bifida – a new cuff position
Neurogenic lower urinary tract dysfunctions have an important impact on the quality of life in patients due to spina bifida. The artificial urinary sphincter AMS 800® has been used for years as standardized long-term therapy in patients with severe stress incontinence. A robot-assisted subprostatic cuff positioning around the membranous urethra has not yet been described in the literature.
This video shows the robot-assisted AMS 800®-sphincter implantation in a 43-year-old patient with neurogenic voiding dysfunction as a result of impaired detrusor contractility due to spina bifida. In this context he underwent previous surgical interventions, namely a bulbar AMS 800®-sphincter implantation in April 2002 and a bulbar double-cuff implantation in January 2003. About 14 years later the patient now complains about progressive stress incontinence. After initiating a transperitoneal approach we performed the extraperitonealisation of the bladder and the incision of the endopelvic fascia in a first step. This was followed by the enlacement and measurement of the membranous urethral circumference. The cuff was positioned at the implant site with mesh towards the outside and &[laquo]pillow&[raquo] side towards the urethra. The pressure-regulating balloon was implanted through the 12 mm trocar and the connecting-tubing through another suprapubic trocar. After tunnelling through the trocar position and creating a dependent subdartos pouch in the scrotum, the control pump was placed into the scrotal pouch. The balloon was filled with 22 ml dilute Iopamiro 300 / Aqua Dest. (57 ml/60 ml) solution and the procedure was completed with the &[laquo]Quick Connection&[raquo] of the tubing.
The blood loss was irrelevant and there were no intra- or postoperative complications. The newly implanted membranous AMS 800®-sphincter has been activated at about 6 weeks postoperative. 6 months after surgery the patient showed a satisfying continence with a use of 1-2 pads per day (preoperative 5-6 pads/day).
The subprostatic, robot-assisted implantation of an AMS 800® around the membranous urethra is a new minimal-invasive therapeutic option. To our knowledge, this approach is described so far for the first time in the literature.