Over the past 5 years, robot-assisted artificial urinary sphincter (AUS) has been used increasingly. However, the feasibility of this procedure remains to be demonstrated in complex cases which could remain indications for open implantation. The objective of this video was to present a case of robot-assisted AMS 800 AUS implantation in a neurological patient with an history of augmentation cystoplasty ad appendicovesicostomy

We present the case of a 32-year-old female patient with myelomeningocele and an history of augmentation cystoplasty + Mitrofanoff catheterizable channel creation at the age of 9. She presents with stress urinary incontinence due to intrinsic sphincter deficiency with a 24h pad weigh test of 350 g, no detrusor overactivity and normal bladder compliance on filling cystometry. She was leaking during cough stress test with no urethral hypermobility. She was offered three surgical options: pubovaginal sling, bladder neck closure, or robotic bladder AUS implantation. She opted for the later option

The standard robotic AUS “anterior” implantation technique was used. The procedure was done transperitoneally. The bladder is filled with saline right from the beginning to identify clearly its boundaries. A catheter is placed in the catheterizable channel to identify its location so that it would not be injured. The Retzius space is dissected carefully until the endoplevic fascia is reached on both sides of the bladder neck. The lateral aspects of the bladder are widely dissected. A passage is created lateral to the catheterizable channel allowing a prograsp forceps to access the right vaginal fornix which is dissected to find the vesicovaginal “bold” plane as previously described. The same step is performed on the left side. The bladder neck is dissected under direct vision from one side to another, sized with the measuring tape and the cuff is inserted. The operative time was 230 minutes and the patient was discharged on postoperative day 2 after removal of the catheter. There was no perioperative complicaitonsThe sphicnter was activated after 6 weeks and the patient has been completely dry since then after a follow up of 1 year.

Robot assisted AUS implantation in female patients appears safe effective and feasible even in complex cases including neurological patients with history of augmentation cystoplasty and appendicovesicostomy.

Continence 2S2 (2022) 100487
DOI: 10.1016/j.cont.2022.100487