Robotic artificial urinary sphincter implantation in female patients under constant direct vision

Peyronnet B1, Dubois A1, Lethuillier V1, Haudebert C1, El-Akri M1, Richard C1, Freton L1, Alimi Q1, Manunta A1, Hascoet J1

Research Type

Clinical

Abstract Category

Female Stress Urinary Incontinence (SUI)

Abstract 599
Robotic Bladder Neck, Artificial Urinary Sphincter, Reconstructive, Pediatric and Tapes
Scientific Podium Video Session 36
Saturday 10th September 2022
16:08 - 16:17
Hall K2
Robotic-assisted genitourinary reconstruction Quality of Life (QoL) Stress Urinary Incontinence
1. university of rennes
In-Person
Presenter
Links

Abstract

Introduction
One of the potential advantages of the robot-assisted approach for artificial urinary sphincter (AUS) implantation in female patients would be to allow direct vision throughout the dissection of the bladder neck. However, this was not the case in the technique initially described (Fournier, Urology 2014) in which the posterior aspect of the bladder neck was dissected blindly. The objective of this video was to describe a change modified robotic anterior AUS implantation in female patients with constant direct vision during bladder neck dissection.
Design
We present the case of a 57-year-old female patient with a history of TOT in 2017 referred recurrence of stress urinary incontinence. She was wearing 4 pads per day, with a 24h pad weight test of 350g. The cystoscopy did not show any sling extrusion. On physical examination, she had a positive cough stress test with a fixed urethra, no pelvic organ prolaps. On preoperative urodynamics, the maximum urethral closure pressure was 16 cmH2O, there was no detrusor overactivity but a poor bladder contractility (PdetQmax=14 cm H2O, Q max=13 ml/s), post-void residual=10 ml. She was offered four therapeutic options: pubovaginal sling, Bulkamid periurethral injections, Adjustable Continence therapy periurethral balloons or robotic AUS implantation and elected this later option.
Results
The patient is placed in 23° Tredelenburg at 23° position with side-docking of the Da Vinci Xi Robot . A transperitoneal approach is used. After bladder filling, the Retzius space is dissected to reach the endopelvic fascia on bothside of the bladder neck. The lateral aspects of the bladder are dissected extensively on both sides. Dissection of the vaginal fornix helped by the assistant finger placed in the vagina is more extensive than in the initial technique, aiming to free the fingertip widely. This will allow a large mobilization of the bladder neck during the dissection granting a direct vision during the dissection of the posterior aspect of the bladder neck using the medial prograsp as a retractor to move the bladder neck medially and upwards.
Conclusion
We describe here a modified anterior technique of robotic AUS implantation in female patients that allows continuous direct vision during the bladder neck dissection and may reduce the risk of intraoperative bladder neck and vaginal injury
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee CNIL Helsinki Yes Informed Consent Yes
Citation

Continence 2S2 (2022) 100488
DOI: 10.1016/j.cont.2022.100488

31/10/2024 05:10:41