The robotic female artificial urinary sphincter (FAUS) represents a alternative treatment for patients with stress urinary incontinence (SUI) refractory to previous incontinence surgeries. The aim of this study is to analyze the outcomes of refractory SUI treatment through robotic FAUS implantation.

Prospective descriptive study of the first 22 consecutive robotic FAUS procedures performed between September 2018 and November 2023. The AMS 800® sphincter was used in all patients. Baseline characteristics, previous history of SUI surgery, intraoperative variables, complications, and functional outcomes were collected. Postoperative outcomes were determined by the use of diapers or sanitary pads, 24-hour pad-test, and the ICIQ-SF questionnaire. Treatment satisfaction was measured using the PGI-I questionnaire. Success was defined as complete continence (absence of diapers or pads usage, postoperative pad-test of 0 grams, and clinical improvement), or improved incontinence (use of 1 sanitary pad per day or a pad-test improvement of at least 50%).

Mean age was 57.3 years (SD 11.3). Mean follow-up was 18.3 months (SD 16.2). 20 patients (90.9%) had undergone at least one previous SUI surgery. Mean surgical time was 179.7 minutes (SD 61.6). Mean hospital stay was 2.5 days (SD 1.4). There was no need for conversion to open surgery in any patient. In 10 patients (45.5%), intraoperative bladder injury occurred at the bladder dome, resolved in all cases by cystorrhaphy and sphincter implantation without complications. 4 patients (18.1%) experienced early complications (within 30 days) Clavien I and II. Complete cure rate of SUI was 86.4% (19 patients) and clinical improvement was observed in another 9.1% (2 patients). The mean reduction in pad test was 789.8 grams (805 Vs 15.2) and in ICIQ-SF was 17.3 points (18.9 Vs 2.9). 21 patients (95.4%) reported feeling better or much better after implantation, and 1 patient (4.6%) did not perceive any changes. No sphincter was removed due to extrusion or infection, and no mechanical failures occurred.

Over the past few years, robotic artificial urinary sphincter implantation has emerged as a treatment alternative for female patients with failed previous SUI surgery and intrinsic sphincter deficiency (ISD) as the physiopathological mechanism of their incontinence with promising perioperative outcomes. The International Continence Society (ICS) acknowledges this indication with a grade C recommendation in its latest update, as well as other major clinical guidelines on incontinence. 

Our results are consistent with those published in the literature. Chartier et al. published in 2020 (1) their series of 25 patients with 84% complete continence at 19 months without any device extrusion or infection. On the other hand, Peyronnet et al. in a french multicenter study (2) with 18 months of follow-up, similar to our series, reported an 81.6% of complete continence rate with a 2% explantation rate.

Robotic female artificial urinary sphincter represents an effective and safe treatment alternative for patients with stress urinary incontinence refractory to previous surgical treatments, with low complication and explantation rates and a high percentage of success.

Chartier-Kastler E, Vaessen C, Rouprêt M, Bassi S, Cancrini F, Phé V. Robot-assisted laparoscopic artificial urinary sphincter insertion in women with stress urinary incontinence: a pilot single-centre study. BJU Int. 2020 Dec;126(6):722-730. doi: 10.1111/bju.15147. Epub 2020 Aug 3. PMID: 32558978.
Peyronnet B, Capon G, Belas O, Manunta A, Allenet C, Hascoet J, Calves J, Belas M, Callerot P, Robert G, Descazeaud A, Fournier G. Robot-assisted AMS-800 Artificial Urinary Sphincter Bladder Neck Implantation in Female Patients with Stress Urinary Incontinence. Eur Urol. 2019 Jan;75(1):169-175. doi: 10.1016/j.eururo.2018.07.036. Epub 2018 Aug 20. PMID: 30139632.