Hypothesis / aims of study
Artificial urinary sphincter (AUS) is commonly used in France in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). However, female AUS has never been assessed using validated questionnaires so far. The aim of the present study was to assess the functional outcomes of robotic artificial urinary sphincter implantation using validated questionnaires
Study design, materials and methods
The data of all female patients undergoing a robotic AUS implantation at a single academic center between 2014 and 2022 were collected prospectively. Preoperatively, all patients underwent urodynamics and filled out an Urinary Symptoms Profile (USP) questionnaire (SUI subscore /9; overactive bladder subscore /21 ; voiding symptoms subscore /9), a ICIQ-SF questionnaire and a Patient Global Impression of Improvement (PGII). The same questionnaires were filled out at 3 months postoperatively. The impact of AUS implantation on patients’ quality of life was assessed using the question 5 of the ICIQ-SF (ICIQ-qol; /10).
We used paired student t-test to compare preoperative and postoperative variables.
Results
Over the study period, 87 robotic female AUS implantations were performed by two surgeons. Twelve patients had neurogenic SUI (13.8%). The median patients’ age was 66 years (56-73) and 81.1% had a history of previous SUI surgery. 69% of the patient had previous midurethral sling.
The median cuff size was 75 mm. The median operative time was 150 minutes.
There were thirteen intraoperative complications (6 bladder neck injuries and 6 vaginal injuries and one bowel injury; 14.9%) and 23 postoperative complications (26.4%) fifteen Clavien grades 1 or 2 and 1 Clavien 3A and 7 clavien 3B: 4 vaginal exposures, 2 infections, 1 mechanical failure. (major complications rate: 9.2%).
The median length of stay was 2 days.
All patient-reported outcomes were significantly improved at 3 months. The USP SUI subscore decreased from 7.2/9 preoperatively to 0.73/9 at 3 months (p<0.0001), the USP OAB subscore dwindled from 12.5 to 4.9 (p<0.0001) and the ICIQ-SF from 16.5 to 3 (p<0.0001). The AUS implantation improved patients’ quality of life with the ICIQ-qol decreasing from 8.7 preoperatively to 0.96 at 3 months (p<0.0001). The 3-month PGII was 1/7 (very much improved) in 58 patients (78.4%), 2/7 (improved) in 7 patients (9.5%), 3/7 in 4 patients (5.4%) and 4/7 (unchanged) in 3 patients (4.1%), and 5/7 in 2 patients (2.7%). There were missing PGII score for 13 patients.
Interpretation of results
In our retrospective single academic center cohort, robot-assisted AUS implantation in female patients improved ICIQ short form, ICIQ quality of life and USP scores at 3 months postoperatively.