Dubois Alexandre, Richard Claire, Haudebert Camille, Penafiel Juan, Voiry Caroline, Jezequel Magali, Samson Emmanuelle, Freton Lucas, Manunta Andrea, Hascoet Juliette, Peyronnet Benoit
Department of Urology, University Hospital of Rennes, 2 Rue Henri le Guilloux, Rennes 35000, France.
Department of Urology, University of Rennes, Rennes, France.
Ther Adv Urol. 2025 Jun 9;17:17562872251342699. doi: 10.1177/17562872251342699. eCollection 2025 Jan-Dec.
In recent years, several preliminary reports have suggested that the robot-assisted approach may decrease the surgical morbidity of artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI). However, for now, only short-term outcomes have been reported. The present study aimed to report the 5-year outcomes of robot-assisted AUS implantation in female patients.
All female patients who underwent a robot-assisted AUS implantation between January 2014 and September 2019 at a single academic center were included in a retrospective study. All robot-assisted female AUS implantations performed after September 2019 were excluded to ensure a 5-year minimum follow-up duration. The indication for AUS implantation was SUI due to intrinsic sphincter deficiency. The primary endpoint was the explantation-free survival and revision-free survival.
Forty-two patients were included. The median age was 66 years (28-84), and 83.8% of the patients had a history of previous anti-incontinence procedure. After a median follow-up of 64 months (16-110), 8 patients were lost to follow-up before the 5-year time point. The 5-year estimated revision-free survival was 89.2 and the 5-year estimated explantation-free survival was 88%. Five AUS explantations were needed (11.9%), and six revisions were required (14.3%). The median time to explantation was 14 months. Four explantations (80%) occurred within the first 18 months, and all of them within the first 27 months. Thirty patients (71.42%) had a complete or improved continence with a complete continence rate of 59.52% and an improved continence rate of 11.9%. There were 10 intraoperative complications (23.8%): 5 bladder injuries and 5 vaginal injuries. Thirteen patients had postoperative complications (30.9%), but only two were Clavien grade ⩾3.
The 5-year outcomes of robot-assisted AUS implantation seem to confirm the promising short-term outcomes that have been reported so far, although revision rates increased with time, which warrants further investigation.
近年来，一些初步报告表明，机器人辅助手术方法可能会降低压力性尿失禁（SUI）女性患者人工尿道括约肌（AUS）植入术的手术发病率。然而，目前仅报告了短期结果。本研究旨在报告机器人辅助AUS植入术在女性患者中的5年结果。
纳入2014年1月至2019年9月在单一学术中心接受机器人辅助AUS植入术的所有女性患者进行回顾性研究。排除2019年9月之后进行的所有机器人辅助女性AUS植入术，以确保至少5年的随访时间。AUS植入的指征是由于内在括约肌缺陷导致的SUI。主要终点是无取出存活和无翻修存活。
纳入42例患者。中位年龄为66岁（28 - 84岁），83.8%的患者有既往抗尿失禁手术史。中位随访64个月（16 - 110个月）后，8例患者在5年时间点前失访。5年估计无翻修存活率为89.2%，5年估计无取出存活率为88%。需要进行5次AUS取出（11.9%），需要进行6次翻修（14.3%）。取出的中位时间为14个月。4次取出（80%）发生在最初18个月内，所有取出均在最初27个月内。30例患者（71.42%）尿失禁完全或改善，完全控尿率为59.52%，改善控尿率为11.9%。有10例术中并发症（23.8%）：5例膀胱损伤和5例阴道损伤。13例患者有术后并发症（30.9%），但只有2例为Clavien分级≥3级。
机器人辅助AUS植入术的5年结果似乎证实了迄今为止报道的有前景的短期结果，尽管翻修率随时间增加，这值得进一步研究。
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