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 is surgical. In cases of recurrent SUI after first surgical treatment or when clear intrinsic sphincter insufficiency (ISD) is present, an implantation of an artificial urinary sphincter (AUS) is recommended.
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.
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.
Mean operative time was 119,7±48,9 min without any conversion to laparotomy. With a follow-up of 44,5±40,5 months (range: 1-149), 78,3% were totally continent and 18,6% 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%), acute urinary retentions (6,8%) urethral (4%) and vaginal erosion (2,7%), urgency urinary incontinence (2,7%). Reimplantation of AUS was performed in 13,5% due to mechanical failure (9) and erosion (1). Permanent removal was performed in 10,8%.
To our knowledge, this is the largest series with the longest follow-up on female incontinent patients treated with laparoscopic AUS implantation, maintaining its safety, feasibility and effectiveness, with a very positive impact on the quality of life of these women. This article is protected by copyright. All rights reserved.
BJU international. 2018 Dec 11 [Epub ahead of print]
Damiano Bracchitta, Pedro Costa, Johann Ménard, Pierre-Emannuel Bryckaert, Éric Mandron
Clinique du Pré, Dept of Urology, Technopôle Université, 13 Avenue René Laennec, 72018, Le Mans, France.