BACKGROUND: Implantation of an artificial urinary sphincter (AUS) is used as a last resort in women with stress urinary incontinence (SUI). OBJECTIVE: To assess the early functional outcome after laparoscopic placement of an AUS in women. DESIGN, SETTING, AND PARTICIPANTS: Twelve women with type 3 SUI underwent a laparoscopic AUS placement between 2006 and 2008. Eleven (92%) had previously undergone anti-incontinence procedures. INTERVENTION: The AUS was implanted with laparoscopic access either preperitoneally or intraperitoneally. The cuff was placed around the bladder neck between the periurethral fascia and the vagina. MEASUREMENTS: Perioperative complications were reviewed. To assess resolution of urinary incontinence, all patients were seen at 1, 3, 6, and 12 mo after the surgery and yearly thereafter. RESULTS AND LIMITATIONS: The mean age of subjects was 56.7+/-12 yr (33-78). The mean body mass index was 24+/-2.3 (20-25). The mean preoperative closure pressure was 22+/-10.9 cmH(2)O (4-35). The mean operative time was 181+/-39 min [110-240]. Intraoperative complications occurred in three women (25%), with bladder (n=2) and vaginal (n=2) injuries. These complications required open conversion. AUS implantation was postponed in one case. The mean hospital stay was 7+/-2.3 d (3-11). The bladder catheter was removed after a mean time of 10+/-8 d (2-30). Urinary retention was observed in five cases (45%) after bladder catheter removal. AUS activation was done 4-14 wk after implantation. Mean follow-up was 12.1+/-8 mo (5.2-27). Incontinence was completely resolved in eight women (88%) who underwent complete laparoscopic procedure. The main limitation of the study was the limited length of follow-up. CONCLUSIONS: AUS implantation can be successfully achieved by laparoscopy. It appears to be technically feasible. These results are still preliminary, and further studies of larger populations with longer follow-up are needed to make any statement regarding surgical strategy. 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.
BACKGROUND: Implantation of an artificial urinary sphincter (AUS) is used as a last resort in women with stress urinary incontinence (SUI). OBJECTIVE: To assess the early functional outcome after laparoscopic placement of an AUS in women. DESIGN, SETTING, AND PARTICIPANTS: Twelve women with type 3 SUI underwent a laparoscopic AUS placement between 2006 and 2008. Eleven (92%) had previously undergone anti-incontinence procedures. INTERVENTION: The AUS was implanted with laparoscopic access either preperitoneally or intraperitoneally. The cuff was placed around the bladder neck between the periurethral fascia and the vagina. MEASUREMENTS: Perioperative complications were reviewed. To assess resolution of urinary incontinence, all patients were seen at 1, 3, 6, and 12 mo after the surgery and yearly thereafter. RESULTS AND LIMITATIONS: The mean age of subjects was 56.7+/-12 yr (33-78). The mean body mass index was 24+/-2.3 (20-25). The mean preoperative closure pressure was 22+/-10.9 cmH(2)O (4-35). The mean operative time was 181+/-39 min [110-240]. Intraoperative complications occurred in three women (25%), with bladder (n=2) and vaginal (n=2) injuries. These complications required open conversion. AUS implantation was postponed in one case. The mean hospital stay was 7+/-2.3 d (3-11). The bladder catheter was removed after a mean time of 10+/-8 d (2-30). Urinary retention was observed in five cases (45%) after bladder catheter removal. AUS activation was done 4-14 wk after implantation. Mean follow-up was 12.1+/-8 mo (5.2-27). Incontinence was completely resolved in eight women (88%) who underwent complete laparoscopic procedure. The main limitation of the study was the limited length of follow-up. CONCLUSIONS: AUS implantation can be successfully achieved by laparoscopy. It appears to be technically feasible. These results are still preliminary, and further studies of larger populations with longer follow-up are needed to make any statement regarding surgical strategy. 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.