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.

Expanding the indications of robotic surgery in urology: A systematic review of the literature

“…The authors report good functional outcomes, with no Clavien–Dindo Grade ≥II complications and blood loss of >150 mL in only one patient. However, in a series of four male patients with neurogenic SUI undergoing bladder neck AUS cuff placement, Hervé et al [106] reported ongoing UI in two patients due to insufficient traction of the cuff around the bladder neck.…”

“…Six publications were identified reporting on a RAS approach for AUS implantation. Two case series in men have been reported [102] , [106] , a further three publications were case series in women with SUI (103–105), and one paediatric case report, have been published.…”

Robotic Surgery as Applied to Functional and Reconstructive Urology

“…At a median follow-up of 13 mo, all patients were continent, with no sign of erosion or device malfunction. Although these findings are highly encouraging, another series in four men described persistent incontinence in two patients [43]. Robotic AUS in women has been described by several groups, with evidence of reduced operative time, blood loss, and length of stay as compared with open surgery [44] with similar functional results.…”

Outcomes of robot‐assisted urinary sphincter implantation for male neurogenic urinary incontinence

“…To the best of our knowledge, our present study is the one of the very few to focus solely on the outcomes of R-AUS implantation in adult male neuro-urological patients. Indeed, studies reported in the literature revolved around small numbers of patients, with short-term outcomes [8,16].…”