In neurological male patients, implanting the artificial urinary sphincter (AUS) cuff at the bladder neck is an option aiming to decrease the risk of erosion. The robotic approach may decrease the morbidity of bladder neck AUS implantation but only scant evidence exist. The aim of this study was to report the preliminary results of robot-assisted bladder neck AUS implantation in male patients with neurogenic stress urinary incontinence (SUI)

The charts of all male patients with spina bifida (SB) or spinal cord injury (SCI) who underwent a primary robotic bladder neck AUS implantation at three academic centers between 2011 and 2020 were retrospectively reviewed. The procedure was performed with the Da-Vinci robot (Si and Xi) using a four arm transperitoneal approach. The primary endpoint was continence at 3 months and at the last follow-up categorized as: complete continence (0 pads), improved SUI, unchanged SUI, or worsened SUI. Patient characteristics, perioperative outcomes, and follow-up data were also collected.

Eleven patients were included over the study period: 7 SCI and 4 SB. The median age was 40 years. One patient had a supra-trigonal cystectomy with concomitant robot-assisted augmentation cystoplasty . The median length of hospitalization was 4 days. There were 2 post-operative complications (33.3%): one Clavien 3 and one Clavien 4. After a median follow-up of 14 months, only one explantation was required (16.7%) due to early AUS infection in the patient who had a concomitant augmentation cystoplasty. Three patients underwent device revision at 4, 7 and 12 months respectively for pump repositioning (n=1) and early recurrence of SUI with cuff downsizing in the two later cases. At 3 months and at the last follow-up, four patients had recovered complete continence (36.4%), 6 patients had improvement in SUI (54.5%) and one patient had unchanged incontinence (9%)

Although the sample size was small which prevent to draw robust conclusions, this study is one of the first to report robot-assisted bladder neck implantation in male patients with neurogenic stress urinary incontinence. The results were encouraging although the high rate of early revisions deserve further evaluation. Data comparing robotic and open bladder neck AUS implantation in this population are also needed

In this preliminary experience, robot-assisted bladder neck AUS implantation for neurogenic SUI yielded interesting results. The functional outcomes were satisfactory but the high rate of early revisions, already reported in the literature (Hervé, BMJ case report 2017), should prompt further evaluation in the upcoming years.