Laparoscopic approach for artificial urinary sphincter implantation in women with intrinsic sphincter deficiency incontinence: a single-centre preliminary experience.
BACKGROUND
Implantation of an artificial urinary sphincter (AUS) is used as a last resort in women with stress urinary incontinence (SUI).


OBJECTIVE
To assess the early functional outcome after laparoscopic placement of an AUS in women.


METHODS
Twelve women with type 3 SUI underwent a laparoscopic AUS placement between 2006 and 2008. Eleven (92%) had previously undergone anti-incontinence procedures.


METHODS
The AUS was implanted with laparoscopic access either preperitoneally or intraperitoneally. The cuff was placed around the bladder neck between the periurethral fascia and the vagina.


METHODS
Perioperative complications were reviewed. To assess resolution of urinary incontinence, all patients were seen at 1, 3, 6, and 12 mo after the surgery and yearly thereafter.


CONCLUSIONS
The mean age of subjects was 56.7+/-12 yr (33-78). The mean body mass index was 24+/-2.3 (20-25). The mean preoperative closure pressure was 22+/-10.9 cmH(2)O (4-35). The mean operative time was 181+/-39 min [110-240]. Intraoperative complications occurred in three women (25%), with bladder (n=2) and vaginal (n=2) injuries. These complications required open conversion. AUS implantation was postponed in one case. The mean hospital stay was 7+/-2.3 d (3-11). The bladder catheter was removed after a mean time of 10+/-8 d (2-30). Urinary retention was observed in five cases (45%) after bladder catheter removal. AUS activation was done 4-14 wk after implantation. Mean follow-up was 12.1+/-8 mo (5.2-27). Incontinence was completely resolved in eight women (88%) who underwent complete laparoscopic procedure. The main limitation of the study was the limited length of follow-up.


CONCLUSIONS
AUS implantation can be successfully achieved by laparoscopy. It appears to be technically feasible. These results are still preliminary, and further studies of larger populations with longer follow-up are needed to make any statement regarding surgical strategy.
Department of Urology, Groupe Hospitalo-Universitaire EST, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France. morgan.roupret@psl.aphp.fr
Morgan
M
Rouprêt
Vincent
V
Misraï
Christophe
C
Vaessen
Vincent
V
Cardot
Florence
F
Cour
François
F
Richard
Emmanuel
E
Chartier-Kastler
D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial