The surgical management of female stress urinary incontinence (SUI), with or without combined prolapse treatment, continues to evolve as new technologies have emerged. Placing an artificial urinary sphincter (AUS) is a treatment option of last resort for managing female genuine SUI due to intrinsic urethral sphincter failure. However, open surgical implantation is technically challenging due to the usual history of previous surgery of anti-incontinence/pelvic operations which result in scar tissue. In this study, we assessed the safety, feasibility and efficacy of laparoscopic implantation of the AUS in 25 women with genuine SUI. This is the largest reported series of such patients who had laparoscopic placement of AUS, with the longest follow-up.
All patients had a history of urogynaecological surgery, mainly tension-free obturator or vaginal tape insertion. The average duration of surgery was just over 90 minutes, and the average hospital stay was four days. In six women with urogenital prolapse, laparoscopic anterior and posterior mesh promontofixation was straightforward. During the average follow-up (26 months), two treatment failures were diagnosed due to erosion of the tape through the walls of the vagina, while the remaining patients reported continence, either complete (in 19) or social (in 4). This series shows that the transperitoneal laparoscopic approach might allow AUS implantation to have a greater future role in the treatment of female genuine SUI.
However, the number of patients is still limited and there were no statistically significant differences between our initial and current results. Furthermore, we are performing a prospective comparable study between patients that undergo laparoscopic and open implantation of the AUS for the treatment of genuine SUI, in order to confirm the potential advantages of the laparoscopic approach.