Introduction: Several preliminary series have reported the use of a robotic approach for artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). However, to date, only one small sample single-center series have aimed to compare the outcomes of robotic AUS to the ones of open AUS implantation in female patients. The aim of the present study was to compare the outcomes of robotic vs. open AUS implantation in women with SUI caused by ISD in a large multicenter cohort.
Methods: The data of all female patients who underwent open or robot-assisted AUS implantation for SUI due to ISD from 2006 to 2018 at 10 departments of urology were included in a retrospective study. At the beginning of the study period, all surgeons performing robotic implantation had either no or little (<20 cases) experience of AUS implantation. Conversely, in the open group, two of the 5 surgeons involved had performed > 20 AUS implantations. Perioperative and functional outcomes between the open and robotic groups were compared
Results: 135 patients were included: 71 in the robotic group and 64 in the open group. The mean operative time was longer in the robotic group (179.9 vs. 126.2 min; p<0.0001). The intraoperative complication (i.e. intraoperative bladder neck and/or vaginal injury) rate was higher in the open group (12.7% vs. 27.4%; p =0.03) as were the rate of postoperative complications (15.5% vs. 46.8%; p<0.0001), the rate of “major” Clavien grade=3 complications (2.8% vs. 17.2%; p=0.01) and the length of hospital stay (4.1 vs. 6.5 days; p=0.002). After a median follow-up of 12.2 months and 25.5 months in the robotic and open groups respectively, the rate of patients fully continent (i.e. 0 pad per day) was higher in the robotic group (83.3% vs. 62.3%; p=0,01) as was the estimated 1-year explantation-free survival (98.6% vs. 78.3%; p=0.001; figure 1).
Conclusions: The robot-assisted approach, even when performed by low experienced surgeons in their learning curve, may decrease the perioperative morbidity of AUS implantation in women when compared to the open approach and possibly improve functional outcomes, likely due to a lower explantation rate. Source of