Robot-assisted AMS-800 Artificial Urinary Sphincter Bladder Neck Implantation in Female Patients with Stress Urinary Incontinence

Peyronnet, B.; Capon, G.; Belas, O.; Manunta, A.; Allenet, C.; Hascoët, J.; Calves, Jehanne; Belas, M; Callerot, P.; Robert, G.; Descazeaud, A.; Fournier, Georges

doi:10.1016/j.eururo.2018.07.036

Cited by 46 publications

(20 citation statements)

References 18 publications

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“…Our technique of robotic AUS implantation differs from the ones already reported [7][8][9]14] and is similar to the one reported by Gondran-Tellier et al [10]. Indeed, the dissection of the bladder neck was initiated posteriorly, with the identification of the space between the bladder neck and the anterior vaginal wall.…”

Section: Mucp Cmh 2 O Median (Iqr) 20 (14-25)supporting

confidence: 61%

“…Recently, the robot-assisted laparoscopic approach has been shown to be feasible [7,8]. The robot allows for more dexterity and visibility compared to laparoscopy, providing magnification and advantages for deep pelvic surgery [9]. However, few short-term outcomes of robotic implantation of AUS in women, regarding efficiency and safety, are available in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Robot‐assisted laparoscopic artificial urinary sphincter insertion in women with stress urinary incontinence: a pilot single‐centre study

et al. 2020

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Objective To report the functional outcomes of robot‐assisted laparoscopic artificial urinary sphincter (AUS; AMS 800™, American Medical Systems, Minnetonka, MN, USA) implantation and revision in women with stress urinary incontinence (SUI). Patients and Methods A pilot prospective monocentric study included all consecutive female patients with SUI and undergoing an AUS surgery (implantation or revision) using a robotic approach between 2012 and 2018. The AUS was implanted through a transperitoneal robotic approach. The dissection of the bladder neck was initiated using a posterior approach with a permanent visual control. Intraoperative and early postoperative complications were reported (Clavien–Dindo classification). Continence was defined as no pad usage. Results A total of 41 patients, median (interquartile range [IQR]) age 67.5 (57–74.7) years were included. In the group of 27 patients undergoing an AUS implantation, one conversion to laparotomy, one bladder neck and one ureteric injury occurred. The AUS was not implanted in the two latest cases. Twelve minor (Clavien–Dindo Grade I–II) early postoperative complications occurring in 10 patients were reported. The median (IQR) follow‐up was 19 (11–27) months. The continence rate was 84% (21/25 patients). In the group of 14 patients undergoing an AUS revision, no vaginal or bladder injury was reported. One patient had a bowel injury with conversion to laparotomy without AUS insertion. Two major (Clavien–Dindo Grade III–V) early postoperative complications occurred in two patients: one intraoperative bowel injury, which ultimately resulted in the death of the patient and one device infection requiring an explantation of the AUS. The median (IQR) follow‐up was 18 (13.5–24.2) months. The continence rate was 83.3% (10/12 patients). Conclusion The results obtained after robot‐assisted laparoscopic AUS implantation among women are promising despite the significant morbidity due to previous pelvic surgeries. Longer follow‐up studies are needed.

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Section: Mucp Cmh 2 O Median (Iqr) 20 (14-25)supporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Robot‐assisted laparoscopic artificial urinary sphincter insertion in women with stress urinary incontinence: a pilot single‐centre study

et al. 2020

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“…The search strategy is described in the PRISMA flowchart and the results of the literature review for the systematic review are illustrated in Figure 1. After de-duplication, 90 articles were screened for further analysis and 15 studies (964 women) identified ( Table 1 [14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30]), which included cohorts of patients undergoing AUS implantation. In particular, the studies that fit the Population, Intervention, Control, Outcome (PICO) quality assessment criteria were included in this analysis.…”

Section: Study Selection Study Characteristics and Outcomesmentioning

confidence: 99%

“…The evaluation of the patients included pad tests and did not use validated instruments to quantify continence-related QoL. The median postoperative cure rate (continence rate: no pads) was 77 (61-94%) and the postoperative social continence rate (continence rate: 1-2 pads) was 22 (10-74%) ( Table 2 [14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30]).…”

Section: Short-and Long-term Functional Outcomes and Qolmentioning

confidence: 99%

A systematic review and meta-analysis of clinical and functional outcomes of artificial urinary sphincter implantation in women with stress urinary incontinence

Barakat

Franke

Hijazi

et al. 2020

Arab Journal of Urology

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Objective: To evaluate the complications and results of artificial urinary sphincter (AUS) implantation in women with stress urinary incontinence (SUI). Methods: A selective database search using keywords (1990-2019) was conducted to validate the effectiveness of the AUS in women. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilised. The meta-analysis included 964 women (15 studies) with persistent SUI. The Newcastle-Ottawa score was used to determine the quality of the evidence in each study. The success rate and complications associated with the AUS were analysed. Results: Meta-analysis of the published studies showed that complete continence was achieved at a mean rate of 79.6% (95% confidence interval [CI] 72.2-86.6%) and a significant improvement was achieved in 15% (95% CI 10-25%). The mean (range) follow-up was 22 (6-204) months. The mean number of patients per study was 68. The mean (range) explantation rate was 13 (0-44)%. Vaginal erosion occurred in a mean (range) of 9 (0-27)% and mechanical complications in 13 (0-47)%. Infections accounted for 7% of the complications. The total mean (range) revision rate of the implanted AUS was 15.42 (0-44)%. The mean (range) size of the cuff used was 6.7 (5-10) cm. Conclusion: Our present analysis showed that implantation of an AUS in women with severe UI is an effective treatment option after failure of first-line therapy. However, the currently available study population is too small to draw firm conclusions.

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“…The first descriptions of robot-assisted AUS implantation by Fournier et al [3], Biardeau et al [4] and Peyronnet et al [3][4][5] included, similarly to the open approach, a blind [Correction added on 24 Oct 2019 after first online publication: The Supporting Information has been amended in this version.] dissection step behind the bladder neck with digital vaginal control.…”

Section: Introductionmentioning

confidence: 99%

Robot‐assisted implantation of an artificial urinary sphincter, the AMS‐800, via a posterior approach to the bladder neck in women with intrinsic sphincter deficiency

et al. 2019

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ObjectivesTo describe a new technique for robot-assisted AMS-800 artificial urinary sphincter (AUS) bladder neck implantation in women. Patients and MethodsWe reviewed the medical files of patients who underwent robot-assisted AUS implantation between March 2017 and November 2018 at our centre. All of the implantations were performed using a posterior approach to the bladder neck in order to avoid blind dissection and the risk of vaginal and/or bladder injury. This strategy was viewed as an alternative to the anterior robot-assisted implantation recently described. The AUSs were activated 5 weeks after implantation. Patients were followed up at 3, 6 and 12 months, then annually. ResultsEight patients, with a median age of 64 years, underwent robot-assisted AUS implantation via a posterior approach to the bladder neck. The median preoperative pad weight was 300 g/24 h. The median operating time was 244 min. No peri-operative vaginal and or bladder injuries were observed. At a median of 12 months of follow-up, all the AUSs were functional. Five patients required no protection (62.5%), three had day protection (37.5%), and all said they were satisfied except for one patient (12.5%) who requested treatment for persistent urge incontinence. ConclusionRobot-assisted AUS implantation in women via a posterior approach to the bladder neck is a procedure that is simple, reproducible and safe. The short-term functional results are satisfactory and comparable to those obtained via an open approach. A more long-term comparison of the efficacy and longevity of AUSs implanted using this posterior approach is needed to confirm its benefit compared with the anterior robot-assisted approach and the classic open technique.Keywords surgical technique, intrinsic sphincter deficiency, robotic surgery, artificial urinary sphincter, stress urinary incontinence Abbreviation: AUS, artificial urinary sphincter. Supporting InformationAdditional Supporting Information may be found in the online version of this article:Video S1. Robotic-assisted artificial urinary sphincter (AMS 800) in women: posterior approach. 1080Gondran-Tellier et al.

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Robot-assisted AMS-800 Artificial Urinary Sphincter Bladder Neck Implantation in Female Patients with Stress Urinary Incontinence

Cited by 46 publications

References 18 publications

Robot‐assisted laparoscopic artificial urinary sphincter insertion in women with stress urinary incontinence: a pilot single‐centre study

Robot‐assisted laparoscopic artificial urinary sphincter insertion in women with stress urinary incontinence: a pilot single‐centre study

A systematic review and meta-analysis of clinical and functional outcomes of artificial urinary sphincter implantation in women with stress urinary incontinence

Robot‐assisted implantation of an artificial urinary sphincter, the AMS‐800, via a posterior approach to the bladder neck in women with intrinsic sphincter deficiency

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