V3-02: Robotic-assisted laparoscopic placement of bladder neck artificial urinary sphincter in a male

Video

Introductions and Objectives
Placement of a bladder neck artificial urinary sphincter (AUS) is indicated in select patients with urinary incontinence and the need for frequent urethral manipulation. This procedure is challenging by any approach. We present a step by step video instruction for performing this procedure through a robotic-assisted laparoscopic approach.

Methods
A 24 year old male with transverse myelitis presented with urinary retention requiring clean intermittent catheterization (CIC) as well as severe stress urinary incontinence between catheterizations. Video urodynamic evaluation revealed a large capacity, acontractile bladder along with low valsalva leak point pressure and an open bladder neck during filling. An AUS was placed at the bladder neck to reduce the risk of cuff erosion with CIC while maintaining continence between catheterizations.

Results
The patient remained for one week with a urethral catheter in place through a deactivated AUS. The catheter was then removed and the patient resumed CIC. He was notably incontinent as the device remained deactivated. At 6 weeks the AUS was activated and the patient continued CIC, now continent between catheterizations.

Conclusions
Placement of a bladder neck AUS in a male is challenging. A robotic-assisted approach offers a minimally invasive alternative to the open approach. This video abstract provides a visual step-by-step technique for this procedure.

Funding: none