Urinary Incontinence and Treatment Options

Urinary incontinence is a serious problem as it affects one's quality of life to a greater extent. Artificial urinary sphincter (AUS) implantation is most recommended and is considered the gold standard treatment for stress urinary incontinence (SUI) in men with neurogenic sphincter insufficiency. Recent studies have shown Periprostatic artificial urinary sphincter implantation (pAUSi) is a rare yet relevant indication for male neurogenic SUI.

A new study in European Urology aimed to describe the surgical technique of robot-assisted pAUSi (RApAUSi) and compare the long-term functional results with the open pAUSi (OpAUSi). The study found that RApAUSi was a better alternative to OpAUSi, resulting in shorter operative times, less blood loss, and fewer severe complications. Compared with open periprostatic artificial urinary sphincter implantation (pAUSi), robot-assisted pAUSi leads to faster recovery and similar functional results.

Researchers conducted a retrospective study and collected data of 65 consecutive men with neurogenic SUI undergoing pAUSi between 2000 and 2022 in a tertiary centre. The surgical procedure included thirty-three patients who underwent OpAUSi and 32 underwent RApAUSi. OpAUSi cases were performed by a single surgeon, experienced in functional urology and prosthetic surgery. RApAUSi cases were performed by the same surgeon together with a second surgeon, experienced in robotic surgery. Researchers looked for outcome measures such as complete urinary continence, intra- and postoperative complications, and surgical revision–free survival (SRFS).

Key Findings of the Study

• RApAUSi showed superior results to OpAUSi in terms of median (interquartile range) operative time (RApAUSi: 170 [150–210] min vs OpAUSi: 245 [228–300] min; p < 0.001).
• Estimated blood loss (RApAUSi: 20 [0–50] ml vs OpAUSi: 500 [350-700] ml; p < 0.001), and median length of hospital stay (LOS; RApAUSi: 5 [4–6] d vs OpAUSi: 11 [10–14] d; p < 0.001).
• Clavien-Dindo grade ≥3a complications occurred more frequently after OpAUSi (RApAUSi: 1/32 [3%] vs OpAUSi: 10/33 [30%]; p = 0.014).
• Achievement of complete urinary continence (zero pads) was comparable between the groups (RApAUSi: 24/32 [75%] vs OpAUSi: 24/33 [73%]; p = 0.500).
• The median follow-up periods were 118 (50–183) and 56 (25–84) months for OpAUSi and RApAUSi, respectively (p < 0.001).
• A tendency towards longer SRFS was observed in the RApAUSi group (p = 0.076). The main study limitation was its retrospective nature.

Researchers concluded that “RApAUSi is an efficient alternative to OpAUSi, resulting in shorter operative times, less blood loss, fewer severe complications, and a shorter LOS with similar functional results and need for revision surgery.”

Reference: Edward Lambert, Emmanuel Chartier-Kastler et al; Robot-assisted Periprostatic Artificial Urinary Sphincter Implantation in Men with Neurogenic Stress Urinary Incontinence: Description of the Surgical Technique and Comparison of Long-term Functional Outcomes with the Open Approach; European Urology, https://doi.org/10.1016/j.eururo.2023.09.025