No abstract

Objectives To update the outcomes and analyse the safety of laparoscopic implantation of an artificial urinary sphincter (AUS) in women with stress urinary incontinence (SUI) as a result of intrinsic sphincter deficiency (ISD). Patients and Methods Seventy‐four women with SUI caused by ISD underwent laparoscopic AUS implantation between 2005 and 2018 in our centre. Urodynamic assessment was required. The AUS was implanted using a transperitoneal laparoscopic approach to the Retzius space. The cuff was placed around the bladder neck between the peri‐urethral fascia and the vagina. Postoperative functional outcomes were defined as success (total continence), improvement (>50% decrease in number of leakages or in number of pads used), or failure (<50% improvement, persistent or increased leaking). Data on peri‐operative and long‐term complications were also collected. Results The mean ± sd operating time was 119.7 ± 48.9 min, with no conversion to laparotomy. With a mean ± sd (range) follow‐up of 44.5 ± 40.5  (1–149) months, 78.3% of the women were totally continent and 18.6% reported improvement. One vaginal and one urethral perforation were the only intra‐operative complications, both solved during surgery. Late complications included recurrent urinary tract infection (5.4%), acute urinary retention (6.8%), urethral (4%) and vaginal erosion (2.7%), and urgency urinary incontinence (2.7%). Reimplantation of AUS was performed in 13.5% of the women as a result of mechanical failure (n =9) and erosion (n = 1). Permanent removal was performed in 10.8%. Conclusion To our knowledge, this is the largest series with the longest follow‐up of women with urinary incontinence treated with laparoscopic AUS implantation, demonstrating its safety, feasibility and effectiveness, and showing a very positive impact on the quality of life of the women.

No abstract

No abstract