The association between pelvic organ prolapse (POP) and stress urinary incontinence (SUI) is very common. The treatment of both conditions can be performed simultaneously or in two separate surgical procedures. The aim is to assess the feasibility and effectiveness of combined treatment with sacrocolpopexy plus artificial urinary sphincter (AUS) through robot-assisted laparoscopic approach.

A 61-year-old woman referred from gynecology for POP and urinary incontinence. Physical examination revealed severe SUI with negative Marshall-Bonney test and stage III cystocele. Videourodynamic study showed SUI with funneling image of the bladder neck and leak pressure point <50 cmH2O confirming the diagnosis of intrinsic sphincter deficiency (ISD). Due to pelvic organ prolapse with sphincter incompetence, it was decided to associate both procedures and perform them simultaneously.  

The surgery begins with dissection of the posterior compartment up to the levator ani muscles. Introduction and fixation of the posterior arm of the mesh. Opening and dissection of the vesicovaginal space and latero-vesical compartments. Incidental opening of the bladder wall, which was closed by primary cystorrhaphy. Communication of the posterior compartment with both lateral vesical spaces. Placement of the anterior mesh, passage through the right broad ligament of the uterus, and fixation of both arms to the promontory. Dissection of the anterior surface of the bladder neck and measurement without tension (8cm). Introduction of the cuff and placement around the bladder neck. Passage of the reservoir and then filled with 24 cc. Externalization of connection tubes, placement of activation pump in the right major labia, and creation of connections.

Surgical time was 180 minutes. The patient had no complications and was discharged 24 hours after the procedure. At 6 months follow-up, the patient is satisfied (PGI-I:1), continent (ICIQ-SF: 0-never), with good management of the AUS, and without prolapse recurrence.

Simultaneous surgical treatment of ISD-associated SUI and concomitant POP using a robotic approach is a viable option that can be safely performed with good outcomes and a low rate of intra- and postoperative complications, while offering the patient with the benefit of resolving both conditions with shorter hospital stay and early functional continence.