Robotic artificial urinary sphincter (AUS) implantation in women has spread significantly in several countries. However, data on robotic AUS implantation in female patients remain relatively limited. The aim of this study was to report the perioperative and functional outcomes of robotic AUS implantation in women.

All female patients who underwent robotic AUS implantation using a standardized technique (anterior approach) between 2013 and 2021 at sixteen European institutions were included in a retrospective study. The indication for AUS implantation was type III stress urinary incontinence and intrinsic sphincter deficiency defined as a combination of a low urethral closure pressure/Valsalva leak point pressure and loss of urethral mobility. In all centers involved, the robotic approach was the only approach used for AUS implantation in female patients over the study period. The primary endpoint was the functional outcome categorized as dry (0 pads), improved or unchanged.Means and standard deviations were reported for continuous variables, and proportions for nominal variables. Revision-free survival and explantation-free survival were estimated using a Kaplan-Meier analysis. Statistical analyses were performed using JMP v.12.0 software (SAS Institute Inc., Cary, NC, USA).

One hundred and eighty-two patients underwent robotic AUS implantation. The median age was 67 years and 86.3% had a history of at least one previous anti-incontinence procedure. Fifteen patients had neurogenic stress urinary incontinence. There were 26 intraoperative complications (15.6%): 14 bladder neck injuries and 12 vaginal injuries. Surgeons carried on with AUS implantation in all except one case. Thirty-eight patients experienced postoperative complications (22.3%) but only ten were Clavien ≥3 (5.5%). After a median follow-up of 12 months, there were 11 AUS explantations performed in total (6.1%) including 8 for urethral extrusion or vaginal exposure (4.4%). The 5-year estimated explantation-free survival was 88.8% (see figure). There were 11 explantations (6.1%) with eight being due to device extrusion or exposure (4.4%). There were 10 revisions (5.6%). At the last follow-up visit, 152 patients were dry (83.5%), 15 were improved (8.2%) and 15 were unchanged (8.2%).

In this large international multicenter series, robotic AUS implantation was associated with promising perioperative and functional outcomes. This series confirms the reproducibility of the robotic “anterior” technique of female AUS implantation.It appeared to be less technically challenging than open AUS implantation, this might help decreasing the surgical morbidity and could contribute to a wider use of this therapeutic option in women with SUI

Robotic AUS implantation in female patients appears feasible and reproducible accross multple surgeons with better perioperative and functional outcomes that those reported in historical open female AUS series.