Introduction & Objectives
Artificial urinary sphincter (AUS) is commonly used in France in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). However, female AUS has never been assessed using validated questionnaires so far. The aim of the present study was to assess the functional outcomes of robotic artificial urinary sphincter implantation using validated questionnaires.
Materials & Methods
The data of all female patients undergoing a robotic AUS implantation at a single academic center between 2014 and 2023 were collected prospectively. Preoperativley, all patients underwent urodynamics and filled out an Urinary Symptoms Profile (USP) questionnaire (SUI subscore /9; overactive bladder subscore /21 ; voiding symptoms subscore /9), a ICIQ-SF questionnaire and a Patient Global Impression of Improvement (PGII). The same questionnaires were filled out at 3 months postoperatively. The impact of AUS implantation on patients’ quality of life was assessed using the question 5 of the ICIQ-SF (ICIQ-qol; /10).
Results
Over the study period, 101 robotic female AUS implantations were performed by three surgeons. Twelve patients had neurogenic SUI (11.8%). The median patients’ age was 66 years (IQR: 53-73) and 86.9% had a history of previous SUI surgery. The median cuff size was 75 mm (IQR:70-80). There were sixteen intraoperative complications (7 bladder neck injuries and 9 vaginal injuries ; 15.8%) and 26 postoperative complications (25.7%) all Clavien grades 1 or 2 except seven Clavien 3B: four early vaginal erosion with AUS explantation, one suspicion of AUS infection with surgical exploration, one incisional hernia with bowel obstruction and one early pump repositionning (major complications rate: 6.8 %). The median length of stay was two days (IQR: 1-3). All patient-reported outcomes were significantly improved at 3 months. The USP SUI subscore decreased from 7.3 preoperatively to 0.8 at 3 months (/9; p<0.0001), the USP OAB subscore dwindled from 12.6 to 5.1 (/21; p<0.0001) and the ICIQ-SF from 16.5 to 3.1 (/21; p<0.0001). The AUS implantation improved patients' quality of life with the ICIQ-qol decreasing from 8.8 preoperatively to 0.9 at 3 months (/10; p<0.0001). The 3-month PGII was 1/7 (very much improved) in 79 patients (78.8%), 2/7 (improved) in seven patients (6.8%), 3/7 (slightly improved) in six patients (5.8%) and 4/7 (unchanged) in nine patients (8.8%).
Conclusions
Robot-assisted AUS implantation in female patients has a low morbidity and improves the patients-reported outcomes and quality of life of female patients with SUI due to ISD.
