Continence for neurological bladder patients is a challenging goal, especially for the women population. Urinary incontinence is often mixed and severe, associated with disabilities and complex medical and surgical history. Two techniques are commonly used, mostly based on the country’s regulations, but never compared to each other: the robotic Artificial Urinary Sphincter (AUS) [1] or the fascial Urethral Sling (US) [2]. We described and analyzed two groups managed with each technique and their respective outcomes.

This retrospective international multicenter study was conducted from October 1st, 2014, to March 31st, 2023. We reviewed records for all women with a past medical history of neurogenic bladder who underwent surgery for robotic AUS or a fascial US (cadaveric or fascia lata). Based on the clinical record, we reported epidemiological data, pre- and post-operative at three months and the last follow-up symptoms, questionnaires (USP, ICIQ), and urodynamics when available.

The AUS (n=15) was older than the US group (n-11), with 40% spina bifida and 63% spinal cord injury. The AUS presented two ileal augmentations, and the US three and five Indiana pouches. Both groups presented with mixed incontinence, with a lower bladder capacity for the US group. We showed no difference in operating time, blood loss, and length of stay. Only four postoperative Clavien I-II complications occurred. There were only one explantation and one revision in the AUS group. 
At three months, for AUS and US, respectively, one patient in each group presented stress incontinence; one and four patients had intermittent catheterization; three patients had an indwelling catheter in the US group. The median follow-up was up to one year, with one and seven patients with intermittent catheterization, and four indwelling catheters in the US group.

This study is the first to evaluate the results of these two mini-invasive techniques together.
The robotic approach is feasible in selected neurological patients; there were few complications for a comparable operative time and positive results, with only one incontinent patient in each group. The sling was chosen more often in patients with intermittent catheterization and bladder augmentation. The four patients with indwelling catheters at one-year follow-up suggest the sling is less effective. We must remain cautious given the small number of patients and the different age groups.

AUS and fascial US are two procedures surgeons most commonly consider in neurological women with favorable continence results. The need to catheterize the patients after surgery needs further analysis to assist the decision-making.

Peyronnet B, Capon G, Belas O, et al. Robot-assisted AMS-800 Artificial Urinary Sphincter Bladder Neck Implantation in Female Patients with Stress Urinary Incontinence. Eur Urol. 2019;75(1):169-175. doi:10.1016/j.eururo.2018.07.036
Peng M, Sussman RD, Escobar C, et al. Rectus Fascia Versus Fascia Lata for Autologous Fascial Pubovaginal Sling: A Single-Center Comparison of Perioperative and Functional Outcomes. Female Pelvic Med Reconstr Surg. 2020;26(8):493-497. doi:10.1097/SPV.0000000000000761