title: Robot-assisted laparoscopic artificial urinary sphincter insertion in men with neurogenic stress urinary incontinence.
abstract: OBJECTIVE
  To describe for the first time the technique of robot-assisted artificial urinary sphincter (R-AUS) insertion in male patients with neurogenic incontinence.
  
  
  METHODS
  From January 2011 to the present date, six patients with spinal cord injury have undergone R-AUS insertion at our academic institution and we have prospectively collected data on pre-, peri- and early postoperative outcomes. A transperitoneal five-port approach was used using a three-arm standard da Vinci® robot (Intuitive Surgical, Sunnyvale, CA, USA) in a 30° reverse Trendelenburg position. The artificial urinary sphincter (AUS) cuff was placed circumferentially around the bladder neck, the reservoir was left intra-abdominally in a lateral vesicular space and the pump was placed in a classic scrotal position.
  
  
  RESULTS
  All six patients had successful robotic implantation of the AUS. The median patient age was 51.5 years, the median (range) operating time was 195 (175-250) min with no significant blood loss or intra-operative complications. The median (range) length of hospital stay was 4 (4-6) days. At a median (interquartile range) follow-up of 13 (6-21) months, all six patients had a functioning device with complete continence. To date, we have observed no incidence of early erosion, device infection or device malfunction.
  
  
  CONCLUSIONS
  Allowing for the preliminary nature of our data, R-AUS insertion appears safe and technically feasible. Larger studies with long-term follow-up and comparison with open AUS insertion are necessary before definitive statements can be made for R-AUS in respect of complications and functional outcomes.
authors.affiliation: Academic department of Urology, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France.
authors.forename: David R
authors.initials: DR
authors.lastname: Yates
authors.forename: Véronique
authors.initials: V
authors.lastname: Phé
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Christophe
authors.initials: C
authors.lastname: Vaessen
authors.forename: Jérôme
authors.initials: J
authors.lastname: Parra
authors.forename: Pierre
authors.initials: P
authors.lastname: Mozer
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D012371:Robotics; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000150:complications*; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D013520:Urologic Surgical Procedures / Q000379:methods