Hypothesis / aims of study
Introduction
Female artificial urinary sphincter (fAUS) implantation represents a salvage option in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD), particularly after failure of previous surgical treatments. Although the recent expansion of this procedure has been largely driven by robotic surgery, laparoscopy may offer a minimally invasive, reproducible, and safe alternative.
Objective
To evaluate perioperative and functional outcomes of laparoscopic fAUS implantation in a tertiary referral center and to descriptively compare these results with contemporary literature, predominantly based on robotic approaches.
Study design, materials and methods
A single-center retrospective study including a series of 15 women who underwent posterior laparoscopic fAUS implantation (May 2022–March 2026), all performed by a single surgeon. Patients with refractory SUI due to ISD were included. Baseline, perioperative, and functional variables were analyzed (ICIQ-UI-SF, ICIQ-FLUTSsex, ICIQ-LUTSqol, PGI-I, 24-hour pad test). Continence was defined as both social continence and objective dryness at last follow-up. Descriptive (median [IQR]) and inferential analyses (Wilcoxon test) were performed. Revision-free survival was estimated using Kaplan–Meier analysis.
Results
Fifteen patients were included (median age 67 years [59–78.5]), with a high degree of complexity (60% prior incontinence surgery, 46.7% prior mesh removal, 20% neurological disease). Median operative time was 135 minutes [117.5–170], and median hospital stay was 2 days [2–2.5]. Intraoperative complications occurred in 20.0% of cases and postoperative complications (<90 days) in 40.0%, with 6.7% classified as Clavien–Dindo grade ≥III.
A significant improvement was observed in all functional outcomes: ICIQ-UI-SF scores decreased from 19.5 to 3.0 at 6 months and 1.5 at 1 year (p<0.001), and the 24-hour pad test decreased from 1250 mL to 70 mL (p<0.001). Objective dryness rate was 78.6% at both 6 months and 1 year, while social continence reached 93.3%.
One revision (6.7%) was recorded due to pump extrusion requiring partial explantation at 240 days, with no complete explants. Revision-free survival was 93.3%. Outcomes were comparable to those reported in robotic series, with continence and reintervention rates within the lower range of published data.
Interpretation of results
According to the European Association of Urology, the female artificial urinary sphincter (AUS) is reserved for refractory stress urinary incontinence in specialized centers. Our cohort, characterized by high complexity, appropriately reflects this indication. Continence outcomes (93.3% social continence, 78.6% objective dryness) are consistent with leading series (70–85%), with significant quality-of-life improvement.
The posterior laparoscopic approach demonstrates perioperative and functional outcomes comparable to robotic surgery, for which no clear clinical superiority has been established, supporting laparoscopy as an accessible alternative. Complication and revision rates (6.7%) are in line with reports in complex populations, with high revision-free survival (93.3%).
Despite limitations (retrospective design, small sample size), our findings support laparoscopic AUS as a safe and effective option in experienced centers, consistent with current European recommendations.