Artificial urinary sphincters: Open surgery and robot-assisted surgery compared

This study compared outcomes of open and robot-assisted surgery for artificial urinary sphincter (AUS) implantation in women. Researchers provided preliminary evidence that robot-assisted AUS surgery can reduce complication rates compared to open surgery. 

Dysfunction of the sphincters of the urethra (urine tract) is a common cause of stress urinary incontinence. Artificial urinary sphincters (AUS) can help restore continence among those with severe urethral sphincter dysfunction (also called intrinsic sphincter deficiency). An AUS consists of an inflatable cuff that fits around the bladder base at the upper part of the urethra. Inflation and deflation of the cuff mimic the function of a biological urethral sphincter. AUS are usually implanted through an incision in the abdomen.

AUS are generally associated with good treatment outcomes and patient satisfaction. However, side effects and risks associated with open surgery have prevented a more widespread use. Robot-assisted keyhole (or larparoscopic) surgery for AUS has recently been under the focus of investigation as a less invasive alternative. This type of surgery involves multiple small incisions, rather than the one large incision used for open surgery.

This study aimed to compare the safety and effects of open and robot-assisted AUS surgery in women.

The records of 24 women were included in analysis. All women underwent AUS implantation for severe urethral sphincter dysfunction. 16 women underwent open surgery. 8 women received robot-assisted keyhole surgery. 92% of women had previously received treatment with a vaginal sling procedure. Treatment outcomes were compared and followed-up for 1 year.

Urinary symptoms were significantly reduced following both surgical procedures. Continence (no urine leakage over 3 days) was achieved in 85.7% of women undergoing robot-assisted surgery. This was comparable to 76.9% of women undergoing open surgery.

There were no significant differences in operation time, blood loss or complications during surgery across the two techniques. However, the rate of complications after surgery was significantly higher with open surgery. 75% of women experienced complications after open surgery, compared to 25% of women after robot-assisted surgery. Hospital stays were slightly longer following open surgery (average 9.3 days) compared to robot-assisted surgery (average 3.5 days).

The AUS device had to be removed (due to infection or erosion) in 3 women in the open surgery group and in 1 woman in the robot-assisted group. 2 AUS device revisions were needed in the open surgery group due to persistent incontinence.

Researchers concluded that robot-assisted surgery for AUS can be a suitable alternative to open surgery.

Larger randomized trials are needed to confirm these preliminary results.