Laparoscopic implantation of artificial urinary sphincter in women with intrinsic sphincter deficiency: Mid-term outcomes.

OBJECTIVES

To analyze the safety and the mid-term continence rates of laparoscopic implantation of artificial urinary sphincter in women.

METHODS

A total of 52 women with intrinsic sphincter deficiency underwent a laparoscopic artificial urinary sphincter implantation from 2005 to 2015 at Surgical Clinic Du Pré, Le Mans, France. The artificial urinary sphincter was implanted around the bladder neck by a transperitoneal laparoscopic approach to the Retzius space. Urodynamic assessment was carried out. Postoperative functional outcome was defined as success (no leaking, no pad use), improvement (>50% decrease in number of leakages, >50% decrease in number of pads used or use of light protection) or failure (<50% improvement, persistent or increased leaking). Outcome measures also included perioperative and long-term complications.

RESULTS

The mean age of the patients was 69.1 years (range 64-82 years). After a mean follow up of 37.5 months (median 24 months; range 1-125 months), 38 (77.6%) patients were considered to be continent (no leakage, no pads), and eight (16.3%) improved their grade of incontinence. Three patients abandoned the follow-up schedule and were excluded. There was no perioperative severe complication. Artificial urinary sphincter revision was needed in 11 (22.4%) patients, requiring a total of seven redo procedures and four permanent sphincter removals. The main reasons for redo procedures were six (11.2%) mechanical problems and one vaginal erosion (2%).

CONCLUSIONS

Herein we report one of the largest series with the longest follow up evaluating the outcomes of laparoscopic artificial urinary sphincter implantation in female patients. This approach seems to be a safe and effective treatment option for patients with intrinsic sphincter deficiency.