The use of artificial urinary sphincter (AUS) as treatment for recurrent stress urinary incontinence (SUI) might be useful in woman with previous surgeries. Its laparoscopic implatation can be done with low morbility

44-year-old woman with SUI. Previously treated with TOT placement (November 2021) obtaining bad postoperative outcome. 
Pelvic organ prolapse was discarded, the Marshall-Bonney test was negative and sling`s extrusion was not evidenced. Ultrasound confirmed the correct placement of the sling and intravesical extrusion is discarded with a cystoscopy.  The videourodynamic study showed findings compatible with Intrinsic Sphincter Deficiency (bladder neck funneling and a Valsalva leak point pressure < 60 cmH2O; bladder compliance and detrusor function were normal). After discussing all the therapeutic options, laparoscopic implantation of an AUS was chosen by the patient.
Through a transperitoneal pelvic laparoscopic approach, the surgery started with the disection of the vesicovaginal space. Laterovaginal spaces were opened up to the endopelvic fascia and then the Retzius space. We stablished a communication between the paravesical space and the retrovesical space avoiding damaging the bladder and the vagina. 
The previously measured (6,5cm) periurethral cuff was adjusted. Though a suprapubic incision the connections were externalized and then the reservoir and the pump were placed in the laterovesical space and the labia majora of the vulva respectively. There were no complications during the surgery.

24h after the surgery the patient was discharged with urethral stent which was removed the fifth day. The sphincter was activated the sixth week after the surgery. 
After 9 months of follow up, the patient was satisfied with the outcomes (PGI-I:1), continent (pad test: 0g) and without Post-Void residual.

AUS is a therapeutic alternative for recurrent SUI management, specially those patients with Intrinsic Sphincter Deficiency diagnosed. Laparoscopic implantation of the AUS is a feasible technique and should be considered in properly selected cases