Evaluating the effectiveness and safety of robot-assisted AUS implantation surgery in women with severe stress urinary incontinence

The study evaluated the effectiveness and safety of robot-assisted artificial urinary sphincter (AUS) implantation surgery in women with severe stress urinary incontinence (SUI). The data found that women with severe SUI showed great improvement with robot-assisted AUS but there was an increased rate of complications.

SUI is a leakage of urine during activities such as sneezing, coughing, laughing, or exercising. SUI happens due to weakness of the pelvic muscles and tissues. There are several treatment options for the management of severe SUI. If conservative treatments such as medications or pelvic floor exercises fail, surgery can be performed.

AUS implantation surgery has been the choice for many surgeons due to its high success rates and low complication rates. AUS involves implanting an inflatable cuff around the urethra (the tube that passes urine out from the bladder). However, this method can be challenging for surgeons due to its anatomical structure. To lessen trauma and complication rates, laparoscopic AUS implantation surgery was developed. Laparoscopy involves surgery into the abdomen through very small holes with special instruments. 

Newer surgical methods involve robot-assisted techniques. The use of robot-assisted AUS implantation surgery has been employed since 2014 but its effectiveness and safety are not clear.

The study analyzed 9 studies that included 157 female patients with severe SUI. All patients underwent robot-assisted AUS implantation surgery.

Robot-assisted AUS implantation surgery was effective for women with severe SUI.

However, the complication rate was high. The intraoperative complication rate was 21% which included bladder and vaginal injury. The postoperative complication rate was 20% and included acute urinary retention, hematoma (a localized pool of blood), and urinary tract infections.

Additionally, a subgroup analysis was also done that compared the traditional approach and the modified posterior approach. This approach is based on how the dissection of the bladder neck is performed. The traditional approach was more effective and safe than the posterior approach. Intraoperative and postoperative complications were higher in the posterior approach.

The study concluded that robot-assisted AUS implantation surgery showed promising results for women with severe SUI but had a high complication rate.

The sample size was small and the follow-up was short. A longer duration of study is needed to have a better idea and guidance for clinical practice. Most studies were based on medical records. There was no comparison group. Further randomized trials are needed.