Robot-assisted bladder neck artificial urinary sphincter implantation in male patient with neurogenic stress urinary incontinence

Bourgeno H1, Richard C1, El-Akri M1, Freton L1, Hascoet J1, Haudebert C1, Bensalah K1, Mathieu R1, Peyronnet B1

Research Type

Clinical

Abstract Category

Continence Care Products / Devices / Technologies

Abstract 600
Robotic Bladder Neck, Artificial Urinary Sphincter, Reconstructive, Pediatric and Tapes
Scientific Podium Video Session 36
Saturday 10th September 2022
16:17 - 16:26
Hall K2
Incontinence Male Quality of Life (QoL)
1. Department of Urology, University of Rennes, France
In-Person
Presenter
Links

Abstract

Introduction
In men with urinary incontinence due to spinal cord injruy, it is recommended to place the artificial urinary sphincter (AUS) cuff around the bladder neck to spare antegrade ejaculation, to avoid the risk of pressure ulcers at the perineal incision site and to limit the risk of cuff erosion due to clean-intermittent-self-catheterization (CISC). The objective of this study was to describe a surgical technique of bladder neck AUS implantation in neurogenic male patients.
Design
The technique of bladder neck AUS implantation in men is described in this video. We present the case of a 43 year-old male with a past medical history of urinary incontinence due to spinal cord injury. The patient performed 5 to 6 CISC per day The maximum urethral closure pressure was 25 cm H2O and no detrusor overactivity evidence on urodynamics. Stress urinary incontinence persisted after  ACT periurethral ballons implantation.
Results
The procedure is performed under general anesthesia. The patient is placed in a 23° Trendelenburg position. A robotic transperitoneal approach is performed and five ports are placed in total, including three ports for the robotic arms and one 12 mm-port for the assistant surgeon to allow the insertion of the AUS cuff.  First, the peritoneum is opened just above the seminal vesicles. The space between the posterior part of the prostate and the seminal vesicles is dissected. The bladder is then released down and the Retzius space is dissected. The lateral sides of the prostate are dissected and the endopelvic fascia is opened on both sides. A Prograsp forceps is used to open the angle between seminal vesicles and bladder on both sides from inside to outside. A measurement tape is then passed around the bladder neck and the AUS cuff is inserted through the 12-mm port. The balloon is implanted in the Retzius space through a 3 cm suprapubic incision and the pump is placed in the scrotum by a subcutaneous passage made from the suprapubic incision.
Conclusion
This video report the feasibility of robot-assisted bladder neck AUS implantation in male patient with spinal cord traumatism incontinence. The benefits of positionning the AUS cuff around the bladder neck (vs. bulbar urethra) and of the robot-assisted approach to perform this bladder neck implantation (vs. open or laparoscopic approaches) remain to be proven by clinical research studies.
Disclosures
Funding None Clinical Trial No Subjects None
Citation

Continence 2S2 (2022) 100489
DOI: 10.1016/j.cont.2022.100489

24/11/2024 22:07:53