Category: Laparoscopic/ Robotic: Other

MP30-9 - Laparoscopic artificial urinary sphincter implantation in women: update on 13 years experience in a single center.

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

Pure stress urinary incontinence (SUI) mainly affects women as a result of pregnancies with laborious delivery, obesity, and pelvic floor dysfunctions. The first therapeutic approach includes life-style interventions, pelvic floor muscle or bladder training. The second-line treatment usually its surgical. In cases of recurrent SUI after first surgical treatment or when clear intrinsic sphincteric insufficiency (ISD) is present, an implantation of an artificial urinary sphincter (AUS) is recommended.
Aim: to update the outcomes and analyze the safety of laparoscopic implantation of AUS in women with SUI due to ISD in a 13 year-long single center experience.

Methods :

74 women with SUI caused by ISD underwent a laparoscopic AUS implantation between 2005-18 in our center. Urodynamic assessment was required. The AUS was implanted by a transperitoneal laparoscopic approach to the Retzius space. The cuff was placed around the bladder neck between the periurethral fascia and the vagina. Postoperative functional outcome was defined as success (total continence), improvement (>50% decrease in number of leakages or in number of pads used), or failure (<50% improvement, persistent or increased leaking). A search on perioperative and long-term complications was also made.

Results :

Patients ́characteristics are summarized in table 1. Mean operative time was 120±40 min without any conversion to laparotomy. With a follow-up of 44.6±40 months (range: 1-149), 77,3% were totally continent and 18,2% reported improvement. One vaginal and one urethral perforation were the only intra-operative complications, both solved during surgery. Late complications included recurrent urinary infections (5,4%), urethral (4,1%) and vaginal erosion (2,7%), urgency urinary incontinence (2,7%). Reimplantation of AUS was performed in 13,5% due to mechanical failure (6), dislodgement of the AUS (3) and erosion (1). Permanent removal was performed in 10,8%.

Conclusions : To our knowledge, this is the largest series with the longest follow-up on female incontinent patients treated with laparoscopic AUS implantation, maintaing its safety, feasibility and effectiveness, with a very positive impact on the quality of life of these women.

Pedro Costa

Urology resident
Urology Department, Clinique du Pré, Le Mans, France
V.N.Gaia, Porto, Portugal

Pedro Costa, MD
Urologist in Centro Hospitalar de Vila Nova de Gaia / Espinho

Damiano Bracchitta

Urology Department, Clinique du Pré, Le Mans, France
Pisa, Toscana, Italy

Kostas Chondros

Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
Heraklion, Iraklion, Greece

Carlos Ferreira

Urology Department, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Portugal
Matosinhos, Porto, Portugal

Johann Ménard

Urology Department, Clinique du Pré, Le Mans, France
Le Mans, Pays de la Loire, France

Pierre-Emmanuel Bryckaert

Urology Department, Clinique du Pré, Le Mans, France
Le Mans, Pays de la Loire, France

Éric Mandron

Urology Department, Clinique du Pré, Le Mans, France
Le Mans, Pays de la Loire, France