Department of Urology, University of Rennes, Rennes, France.
Department of Urology, University of Bordeaux, Bordeaux, France.
Eur Urol. 2019 Jan;75(1):169-175. doi: 10.1016/j.eururo.2018.07.036. Epub 2018 Aug 20.
Widespread adoption of the AMS-800 artificial urinary sphincter (AUS) in female patients has been hampered by the surgical morbidity of its implantation through an open approach.
To describe a standardized technique of robotic bladder neck AUS implantation in female patients, and to report the perioperative and functional outcomes obtained by multiple surgeons with this technique.
DESIGN, SETTINGS, AND PARTICIPANTS: We retrospectively reviewed the charts of all female patients who underwent robotic AUS implantation for urinary incontinence due to intrinsic sphincter deficiency between March 2012 and March 2017 in five institutions. Most of the 10 surgeons involved were not highly experienced in female AUS implantation and/or in robotic surgery.
The AUS is implanted at the bladder neck through a transperitoneal robotic approach. The finger placed by the assistant surgeon in the vagina is paramount to expose the vesicovaginal space and guide the robotic surgeon throughout the bladder neck dissection.
The primary endpoint was the incontinence categorized as complete continence(ie, no pads used), improved incontinence, or unchanged incontinence.
Forty-nine female patients underwent a robotic AUS implantation. There were eight intraoperative complications (16.3%): five bladder neck injuries and three vaginal injuries. Nine patients experienced postoperative complications (18.3%), but only two were Clavien ≥3 (4.1%). After a median follow-up of 18.5 mo, one explantation (vaginal erosion, 2.1%) and three revisions (one mechanical and two nonmechanical failure, 6.1%) were needed. At last follow-up, 40 patients were fully continent (81.6%), six had improved incontinence (12.2%), and three had unchanged incontinence (6.1%).
In this first multicenter series of robot-assisted AUS implantation, our technique appeared feasible, safe, and reproducible with perioperative and functional outcomes in the early learning curve not inferior to those reported in large series of open AUS implantation from tertiary referral centers.
Robot-assisted bladder neck AMS-800 artificial urinary sphincter implantation in female patients with stress urinary incontinence resulting from intrinsic sphincter deficiency is feasible, safe, and reproducible with promising outcomes.
由于植入开放式人工尿道括约肌（AUS）的手术发病率较高，因此广泛采用 AMS-800 女性 AUS 一直受到阻碍。
描述一种标准化的机器人膀胱颈 AUS 植入女性患者的技术，并报告多位外科医生使用该技术获得的围手术期和功能结果。
设计、地点和参与者：我们回顾性分析了 2012 年 3 月至 2017 年 3 月期间，五家机构中因内源性括约肌缺陷导致尿失禁而接受机器人 AUS 植入的所有女性患者的病历。涉及的 10 名外科医生大多数对女性 AUS 植入和/或机器人手术经验不足。
AUS 通过经腹机器人入路植入膀胱颈。助手外科医生放置在阴道中的手指对于暴露阴道膀胱空间并指导机器人外科医生进行整个膀胱颈解剖至关重要。
主要终点是将失禁分为完全失禁（即不使用尿垫）、改善的失禁或不变的失禁。
49 名女性患者接受了机器人 AUS 植入。有 8 例术中并发症（16.3%）：5 例膀胱颈损伤和 3 例阴道损伤。9 例患者发生术后并发症（18.3%），但仅 2 例为 Clavien ≥3（4.1%）。中位随访 18.5 个月后，需要进行 1 次取出（阴道侵蚀，2.1%）和 3 次翻修（1 次机械性和 2 次非机械性故障，6.1%）。末次随访时，40 名患者完全失禁（81.6%），6 名患者改善失禁（12.2%），3 名患者失禁不变（6.1%）。
在这项首次多中心机器人辅助 AUS 植入系列研究中，我们的技术似乎是可行的、安全的，并且在早期学习曲线中具有可重复性，其围手术期和功能结果不劣于来自三级转诊中心的大型开放式 AUS 植入系列报道。
机器人辅助膀胱颈 AMS-800 人工尿道括约肌植入术治疗因内源性括约肌缺陷导致的女性压力性尿失禁是可行的、安全的且可重复的，具有良好的效果。
