title: [Laparoscopic approach for artificial urinary sphincter implantation in women with severe urinary stress incontinence].
abstract: BACKGROUND
  To evaluate, feasibility, efficacy and morbidity of laparoscopic artificial urinary sphincter (AUS) implantation in women with severe stress urinary incontinence.
  
  
  METHODS
  Twenty-six women with severe stress urinary incontinence were treated between October 2007 and January 2012 by laparoscopic implantation of an AUS AMS 800 (American medical Systems, Inc., Minnetonka, Minnesota). For 18 patients AUS was primary implanted and, for eight, AUS was revised for a mechanical failure. Three patients had a concomitant laparoscopic vaginal prolapse repair. Mean value was for age 64 years, BMI 27.8kg/m2, and mean maximal urethral closure pressure was 26.75cm of water. Most of the patients (88%) had a history of pelvic or incontinence surgery. The study was a retrospective analysis of operative parameters, complications and functional results.
  
  
  RESULTS
  Three conversions in open surgery and five bladder injuries were described. Mean operative time was 149 minutes. Bladder catheter was removed at a mean of day 3.8. Mean post-operative stay was 5 days. Early postoperative complications consist in eight acute transient urinary retentions, two pump migrations, and one vaginal injury. Late post-operative complications consist in one vaginal erosion. Explantation of AUS was performed for these last two patients. Mean follow-up was 20 months. Sixteen patients are totally continent, five have a social continence (1 pad/day) and three need more than one pad/day.
  
  
  METHODS
  Our results compare favorably to literature either for laparoscopic or conventional approach with a limited learning curve.
  
  
  CONCLUSIONS
  Laparoscopic implantation of AUS in women with severe stress urinary incontinence was feasible and efficient.
authors.affiliation: Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France. Electronic address: sophia.trolliet@chru-strasbourg.fr.
authors.forename: S
authors.initials: S
authors.lastname: Trolliet
authors.forename: E
authors.initials: E
authors.lastname: Mandron
authors.forename: H
authors.initials: H
authors.lastname: Lang
authors.forename: D
authors.initials: D
authors.lastname: Jacqmin
authors.forename: C
authors.initials: C
authors.lastname: Saussine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D001743:Urinary Bladder / Q000293:injuries; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D016741:Urinary Sphincter, Artificial
keywords: Artificial urinary sphincter; Femme; Incontinence urinaire; Laparoscopie; Laparoscopy; Sphincter artificiel urinaire; Urinary incontinence; Woman