The implantation of an artificial urinary sphincter (AUS) is the last-resort surgical treatment for stress urinary incontinence due to sphincter insufficiency. In women, it can be implanted via an open, laparoscopic, or more recently robotic approach, allowing for continuous visual control during implantation.
 In most cases, the implantation of an AUS allows the patient to have normal spontaneous urination, but the placement of an overly tight cuff may lead to chronic urinary retention and require early revision of the device.

We present the case of a 70-year-old woman with severe urinary incontinence following a pelvic trauma. An initial AMS 800 AUS had been successfully implanted, allowing for a return to full continence with spontaneous urination. She subsequently required a revision of the device after several years due to a recurrence of her stress urinary incontinence, performed via laparoscopy.
 This revision was marked by the absence of spontaneous urination and led the patient to switch to exclusive self-catheterization. A further revision with the assistance of the robotic approach is scheduled.

The patient is positioned in Trendelenburg at 23° with legs apart. A laparoscopic approach is performed, and the various Medtronic robot arms are set up. The Retzius space is opened, which allows easy identification of the previous tubing. Dissection along the upper edge of the tubing is performed to stay clear of the bladder neck, preserving it, and proceed to the cuff. The old device is removed, and the measuring device is placed. The previous laparoscopic dissection likely missed some fibers of the bladder neck, so a new dissection is performed. The total length of the bladder neck is measured at 8 cm. The procedure is completed with the placement of a new artificial sphincter in the usual manner.
The surgery lasted 130 minutes. There were no postoperative complications. After the removal of the Foley catheter, the patient was able to resume spontaneous urination without post-void residuals.

Revision of an AUS can be easily performed with the Medtronic robotic system.
 The robot-assisted approach appears to be an excellent technique for better dissection of the bladder neck and inclusion of all bladder neck fibers, especially after a failed initial revision of the device.