Laparoscopic artificial urinary sphincter implantation in women with stress urinary incontinence: update on 13 years’ experience in a single centre

OBJECTIVES: To update the outcomes and analyse the safety of laparoscopic implantation of an artificial urinary sphincter (AUS) in women with stress urinary incontinence (SUI) as a result of intrinsic sphincter deficiency (ISD). PATIENTS AND METHODS: Seventy-four women with SUI caused by ISD underwent laparoscopic AUS implantation between 2005 and 2018 in our centre. Urodynamic assessment was required. The AUS was implanted using a transperitoneal laparoscopic approach to the Retzius space. The cuff was placed around the bladder neck between the peri-urethral fascia and the vagina. Postoperative functional outcomes were defined as success (total continence), improvement (>50% decrease in number of leakages or in number of pads used), or failure (<50% improvement, persistent or increased leaking). Data on peri-operative and long-term complications were also collected. RESULTS: The mean ± sd operating time was 119.7 ± 48.9 min, with no conversion to laparotomy. With a mean ± sd (range) follow-up of 44.5 ± 40.5  (1-149) months, 78.3% of the women were totally continent and 18.6% reported improvement. One vaginal and one urethral perforation were the only intra-operative complications, both solved during surgery. Late complications included recurrent urinary tract infection (5.4%), acute urinary retention (6.8%), urethral (4%) and vaginal erosion (2.7%), and urgency urinary incontinence (2.7%). Reimplantation of AUS was performed in 13.5% of the women as a result of mechanical failure (n =9) and erosion (n = 1). Permanent removal was performed in 10.8%. CONCLUSION: To our knowledge, this is the largest series with the longest follow-up of women with urinary incontinence treated with laparoscopic AUS implantation, demonstrating its safety, feasibility and effectiveness, and showing a very positive impact on the quality of life of the women.