title: Persistent urinary incontinence after a robot-assisted artificial urinary sphincter procedure: lessons learnt from two cases.
abstract: This case report describes 2 cases of persistent urinary incontinence in the beginning of the learning curve of robot-assisted bladder neck implantation of an artificial urinary sphincter (RA-AUS) in men at risk for erosion due to neurological lesions. Among a series of 4 RA-AUS, 2 patients still experienced urinary incontinence after surgery. A complete urological workup was strictly normal and did not show any device malfunction. However, during an AUS revision in these two patients, exploration revealed that the cuff was not tight enough. This issue was resolved by placing smaller cuffs. After re-do surgery, one of the two patients no longer had urinary incontinence, while the second patient was lost to follow-up. Insufficient tightness of the cuff could be explained by an inability of the surgeon to feel the force while pulling the cuff around the urethra due to the absence of haptic sensation in robotic surgery.
authors: Department of Urology, Universitair Ziekenhuis Gent, Gent, Belgium.
authors: François
authors: F
authors: Hervé
authors: Department of Urology, Universitair Ziekenhuis Gent, Gent, Belgium.
authors: Nicolaas
authors: N
authors: Lumen
authors: Department of Urology, Universitair Ziekenhuis Gent, Gent, Belgium.
authors: An-Sofie
authors: AS
authors: Goessaert
authors: Department of Urology, Universitair Ziekenhuis Gent, Gent, Belgium.
authors: Karel
authors: K
authors: Everaert
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D065287:Robotic Surgical Procedures; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000503:physiopathology*; D016741:Urinary Sphincter, Artificial; D014563:Urodynamics