In recent years, several preliminary reports have suggested that the robotic approach may decrease the surgical morbidity of artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI). However, only short-term outcomes were reported. The aim of the present study was to report the 5-year outcomes of robot-assisted AUS implantation in women.

All female patients who underwent a robot-assisted AUS implantation between February 2014 and October 2018 at a single academic center were included in a retrospective study. The indication for AUS implantation was SUI due to intrinsic sphincter deficiency (ISD) in all cases, i.e. SUI demonstrated at the cough stress test with a fixed urethra, low maximum urethral closure pressure. Revision-free and explantation-free survivals were estimated using Kaplan-Meier analyzes.

31 patients underwent AUS implantation over the study period and were included. The median age was 70 years and 25 patients had a history of previous anti-incontinence procedure. There were 6 intraoperative complications : 3 bladder neck injury and 3 vaginal injury. 11 patients had post-operative complications, 1 Clavien ≥3.

7 patients did not reach the 5-year timepoint : 3 died and 4 were lost to follow-up. After a median follow-up of 62 months, 5 AUS explantations were needed : three for vaginal exposure of the cuff, one for urethral extrusion of a synthetic midurethral sling next to the cuff and one for labial exposure of the pump) and three revisions were required (9.7%): two for mechanical failure and one for inadequate pump positioning. The 5-year estimated explantation-free survival was 82.5% (figure 1) and the 5-year estimated revision-free survival was 88.7%. Among the 5 patients explanted, 3 were reimplanted, 1 underwent a fascial sling and 1 underwent an ileal conduit. Hence, 29 patients had an AUS in situ at the last follow-up visit (93.5%) but 3 of these were permanently deactivated.

At last follow-up, 18 patients reported being dry (58.1%), six were improved (19.4%) and seven were unchanged (22.6%) including the five who had their device explanted or deactivated.

The 5-year outcomes of robot-assisted AUS implantation seems to confirm the promising short-term outcomes that have been reported so far, although revision and explantation rates increased with time as expected.