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Lambert E, Chartier-Kastler E, Vaessen C, Beaugerie A, Cotte J, Roupret M, Mozer P, Parra J, Seisen T, Lenfant L. 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. Eur Urol 2024; 85:139-145. [PMID: 37914580 DOI: 10.1016/j.eururo.2023.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/02/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Periprostatic artificial urinary sphincter implantation (pAUSi) is a rare yet relevant indication for male neurogenic stress urinary incontinence (SUI). OBJECTIVE To describe the surgical technique of robot-assisted pAUSi (RApAUSi) and compare the long-term functional results with the open pAUSi (OpAUSi). DESIGN, SETTING, AND PARTICIPANTS Data of 65 consecutive men with neurogenic SUI undergoing pAUSi between 2000 and 2022 in a tertiary centre were collected retrospectively. SURGICAL PROCEDURE Thirty-three patients 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. MEASUREMENTS Outcome measures were achievement of complete urinary continence, intra- and postoperative complications, and surgical revision-free survival (SRFS). RESULTS AND LIMITATIONS 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) mo 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. CONCLUSIONS 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. PATIENT SUMMARY Compared with open periprostatic artificial urinary sphincter implantation (pAUSi), robot-assisted pAUSi leads to faster recovery and similar functional results, with fewer postoperative complications.
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Affiliation(s)
- Edward Lambert
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; J-ERUS/YAU Academic Urologists Working Group on Robot-Assisted Surgery, Paris, France.
| | - Emmanuel Chartier-Kastler
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Christophe Vaessen
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Aurélien Beaugerie
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Juliette Cotte
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Morgan Roupret
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Pierre Mozer
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Jérôme Parra
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Thomas Seisen
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Louis Lenfant
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
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Harley F, Fong E, Yao HH, Hashim H, O'Connell HE. What credentials are required for robotic-assisted surgery in reconstructive and functional urology? BJUI COMPASS 2023; 4:493-500. [PMID: 37636202 PMCID: PMC10447218 DOI: 10.1002/bco2.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/25/2023] [Accepted: 03/05/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction The increasing popularity of robotic assisted surgery (RAS) as it is implemented in to sub specialities poses many challenges to ensuring standards in quality and safety. The area of Reconstructive and Functional Urology (RFU) has a wide range and largely complex heterogeneous procedures. In recent years RFU has started to incorporate RAS as the primary method to undertake these procedures due to improved vision, dexterity, and access to deep cavities. To ensure patient safety majority of institutions maintain minimal requirements to operate using RAS however across specialities and institutions these greatly vary. Methods A narrative review of all the relevant papers known to the author was conducted. Results Specific challenges facing RFU is the inability to rely on case numbers as a surrogate means to measure competency as well the ongoing consideration of how to differentiate between surgeons with robotic training and those with the clinical experience specific to RFU. Conclusion This review explores current models of training and credentialling and assess how it can be adapted to suggest a standardised guideline for RFU to ensure the highest standards of patient care.
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Affiliation(s)
- Frances Harley
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Eva Fong
- Department of UrologyUrology InstituteAucklandNew Zealand
| | - Henry Han‐I Yao
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Hashim Hashim
- Bristol Urological InstituteSouthmead Hospital, North Bristol NHS TrustBristolUK
| | - Helen E. O'Connell
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Shokri P, Kharaz L, Talebian N, Borumandnia N, Ziaee SAM, Shakhssalim N. A systematic review and meta-analysis of complications of artificial urinary sphincters in female patients with urinary incontinence due to internal sphincter insufficiency. BMC Urol 2023; 23:97. [PMID: 37210489 DOI: 10.1186/s12894-023-01274-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 05/17/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is a common worldwide rising health issue among women with a prevalence of 5 to 70%. Stress urinary incontinence (SUI) is the most common subtype of UI. There are different treatments for UI, including AUS (artificial urinary sphincter) implantation, as one of the surgical options for treating SUI. The aim of this study was to determine the complication rate of AUS, exclusively in female patients with SUI, which resulted from ISD (intrinsic sphincter deficiency). We also compared the complication rate between minimally invasive (laparoscopic or robotic surgery) and open approaches. METHODS Scopus, PubMed, Web of Science, Embase, and Google Scholar were searched for studies regarding complications in AUS implantation surgery, from the beginning of the project to March 2022. After screening and reviewing of full text, the general characteristics of the study and study population including follow-up time, type of surgery, and the number of complications that occurred such as necrosis, atrophy, erosion, infection, mechanical failure, revision, and leak, were extracted. RESULTS We found that atrophy occurred in 1 of 188 (0.53%) patients treated with minimally invasive surgery and in 1 of 669 (0.15%) patients treated with open surgery. None of the 17 included studies reported the occurrence of necrosis in the patients under study. Erosion occurred in 9 of 188 (4.78%) patients treated with minimally invasive surgery and in 41 of 669 (6.12%) patients treated with open surgery. Infection occurred in 12 of 188 (6.38%) patients treated with minimally invasive surgery and in 22 of 669 (3.2%) patients treated with open surgery. The mechanical failure occurred in 1 of 188 (0.53%) patients treated with minimally invasive surgery and in 55 of 669 (8.22%) patients treated with open surgery. Reconstructive surgery occurred in 7 of 188 (3.72%) patients treated with minimally invasive surgery and in 95 of 669 (14.2%) patients treated with open surgery. Leaks occurred in 4 of 188 (2.12%) patients treated with minimally invasive surgery and in 6 of 669 (0.89%) patients treated with open surgery. The type of surgery was associated with a statistically significant increase in mechanical failure (p-value = 0.067) and infection (p-value = 0.021), and reconstructive surgery (p-value = 0.049). Out of the 857 participats in the study,469 were studied for less than five years and 388 were studied for more than five years.21 of 469 (4.4%) (p-value = 0.08) patients and 81 of 388 (20.8%) (p-value = 0.001) patients required reconstructive surgery. Erosion occurred in 23 of 469 (4.9%) (p-value = 0.01)patients with following time less than five years and in 27 of 388 (6.9%) (p-value = 0.001) patients with following time more than five years. CONCLUSION The use of artificial urinary sphincters in the treatment of UI causes complications such as atrophy, erosion, and infection; the amount of which is influenced by the surgical method and the duration of using the artificial urinary sphincter. It seems that the use of new surgical methods, such as laparoscopic surgery, is useful in reducing the incidence of complications.
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Affiliation(s)
- Pourya Shokri
- Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ladan Kharaz
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niki Talebian
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Amir Mohsen Ziaee
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Labbafinejad Medical Center, Pasdaran, Tehran, Iran
| | - Nasser Shakhssalim
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Labbafinejad Medical Center, Pasdaran, Tehran, Iran
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Bazinet A, Vaessen C, Mozer P, Popelin MB, Rod X, Chartier-Kastler E. Robotic-assisted artificial urinary sphincter revisions for women suffering from non-neurogenic stress incontinence: a single center experience. World J Urol 2023:10.1007/s00345-023-04399-8. [PMID: 37055589 DOI: 10.1007/s00345-023-04399-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/01/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE Patients with artificial urinary eventually need surgical revision. Unfortunately, in women, this requires another invasive abdominal intervention. Robotic-assisted revision may provide a less invasive and more acceptable approach for sphincter revision in women. We wanted to determinate the continence status after robotic-assisted artificial urinary sphincter revision among women with stress incontinence. We also examined postoperative complications and the safety of the procedure. METHODS The chart of the 31 women with stress urinary incontinence who underwent robotic-assisted AUS revision at our referral center from January 2015 to January 2022 were reviewed retrospectively. All patients underwent a robotic-assisted artificial urinary sphincter revision by one of our two expert surgeons. The primary outcome was to determinate the continence rate after revision and the secondary outcome aimed to evaluate the safety and feasibility of the procedure. RESULTS Mean patients age was 65 years old, and the mean time between the sphincter revision and previous implantation was 98 months. After a mean follow-up of 35 months, 75% of the patients were fully continent (0-pad). Moreover, 71% of the women were back to the same continence status as with the previously functional sphincter, while 14% even have an improved continence status. Clavien-Dindo grade [Formula: see text] 3 and overall complications occurred in 9% and 20.5% of our patients, respectively. This study is mainly limited by its retrospective design. CONCLUSION Robotic-assisted AUS revision carries satisfying outcome in terms of continence and safety.
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Affiliation(s)
- Amélie Bazinet
- Urologie, Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651, Paris Cedex 13, France.
- Department of Urology, University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Canada.
| | - Christophe Vaessen
- Urologie, Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Pierre Mozer
- Urologie, Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Marie-Bérénice Popelin
- Urologie, Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Xavier Rod
- Urologie, Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Emmanuel Chartier-Kastler
- Urologie, Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
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Lambert E, Lenfant L, Larcher A, Roupret M, Vaessen C, Chartier-Kastler E. Robot-assisted AMS 800 artificial urinary sphincter implantation for stress urinary incontinence in women: Description of the transperitoneal posterior surgical technique. UROLOGY VIDEO JOURNAL 2023. [DOI: 10.1016/j.urolvj.2023.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
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Fan YH, Shen YC, Hsu CC, Chow PM, Chang PC, Lin YH, Chang SJ, Jiang YH, Liao CH, Wang CC, Wu CT, Kuo HC. Current Surgical Treatment for Neurogenic Lower Urinary Tract Dysfunction in Patients with Chronic Spinal Cord Injury. J Clin Med 2023; 12:jcm12041400. [PMID: 36835937 PMCID: PMC9963408 DOI: 10.3390/jcm12041400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
This study aimed to present a comprehensive literature review of the efforts of a spinal cord injury workgroup in Taiwan regarding urologic surgery for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI). Surgical procedures should be viewed as a final option for managing patients with SCI who have persistent symptoms and complications that cannot be resolved by other means. Surgeries can be grouped according to their purpose: reducing bladder pressures, reducing urethra resistance, increasing urethra resistance, and urinary diversion. The choice of surgery depends on the type of LUTD based on urodynamic tests. Additionally, cognitive function, hand motility, comorbidities, efficacy of surgery, and related complications should be considered.
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Affiliation(s)
- Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
| | - Yuan-Chi Shen
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chih-Chen Hsu
- Department of Urology, Taipei Hospital, Ministry of Health and Welfare, Taipei 24233, Taiwan
| | - Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei 10002, Taiwan
| | - Po-Chih Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Yu-Hua Lin
- Department of Chemistry, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Shang-Jen Chang
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei 10002, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
| | - Chun-Hou Liao
- Divisions of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
| | - Chung-Cheng Wang
- Department of Urology, En Chu Kong Hospital, New Taipei City 23702, Taiwan
| | - Chun-Te Wu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
- Correspondence: ; Tel.: +886-3-8561825 (ext. 2117)
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Chung E, Liao L, Kim JH, Wang Z, Kitta T, Lin ATL, Lee KS, Ye L, Chu P, Kaiho Y, Takei M, Jiang H, Lee J, Masuda H, Tse V. The Asia-Pacific AMS800 artificial urinary sphincter consensus statement. Int J Urol 2023; 30:128-138. [PMID: 36375037 PMCID: PMC10100264 DOI: 10.1111/iju.15083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/03/2022] [Indexed: 11/16/2022]
Abstract
This Asia-Pacific (AP) AMS 800™ artificial urinary sphincter (AUS) consensus statement aims to provide a set of practical recommendations to assist surgeons with the AMS 800 device surgery. The AP consensus committee consisted of key opinion leaders with extensive experience with AMS 800 surgery across several AP countries. The panel reviewed and discussed relevant findings with emphasis on locoregional and specific clinical challenges relevant to the AP region. Recommendations were made in key areas namely (1) patient selection and informed consent process; (2) preoperative assessment; (3) dealing with co-existing urological disorders; (4) surgical principles and intraoperative troubleshooting; (5) postoperative care; (6) special populations; and (7) cost analysis and comparative review. The AMS 800 device should be offered to males with moderate to severe stress urinary incontinence (SUI). Full informed consent should be undertaken, and emphasis is placed on surgical contraindications and high-risk candidates. The presence of a surgical mentor or referral to experts is recommended in complex AUS candidates. Preoperative cystoscopy with or without multichannel urodynamic study is necessary and patients with pre-existing urological disorders should be treated adequately and clinically stable before surgery. Adherence to strict patient selection and safe surgical principles are critical to ensure excellent clinical outcomes and minimize complications. Given that InhibiZone-coated device is not available in many AP countries, the use of prophylactic antibiotics pre-and post-operatively are recommended. The AMS 800 device should be prepared according to the manufacturer's guidelines and remains a cost-effective treatment for male SUI. The AMS 800 device remains the surgical benchmark for male SUI but is associated with certain mechanical limitations and a unique set of complications.
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Affiliation(s)
- Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia.,AndroUrology Centre, Brisbane, Queensland, Australia
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Centre and Capital Medical University, Beijing, China
| | - Jang Hwan Kim
- Department of Urology and Urological Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Zhong Wang
- Department of Urology and Andrology, Ninth Hospital of Shanghai Jiaotong University, Shanghai, China
| | - Takeya Kitta
- Department of Urology, Hokkaido University, Sapporo, Japan
| | | | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Liefu Ye
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Peggy Chu
- Department of Surgery, Tuen Mun Hospital, Hong Kong SAR, China
| | - Yasuhiro Kaiho
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Hai Jiang
- Department of Urology, the First Affiliated Hospital of Zhejiang University Medical College, Hangzhou, China
| | - Joe Lee
- Department of Urology, National University Hospital, Singapore
| | - Hitoshi Masuda
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Vincent Tse
- Department of Urology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Tsoi H, Elnasharty SF, Culha MG, De Cillis S, Guillot-Tantay C, Hervé F, Hüesch T, Raison N, Phé V, Osman NI. Current evidence of robotic-assisted surgery use in functional reconstructive and neuro-urology. Ther Adv Urol 2023; 15:17562872231213727. [PMID: 38046941 PMCID: PMC10693211 DOI: 10.1177/17562872231213727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/25/2023] [Indexed: 12/05/2023] Open
Abstract
The use of robot-assisted technology has been widely adopted in urological oncological surgery and its benefits have been well established. In recent years, robotic technology has also been used in several functional reconstructive and neuro-urology (FRNU) procedures. The aim of this review was to evaluate the current evidence in the use of robotic technology in the field of FRNU. We performed a PubMed-based literature search between July and August 2022. The keywords we included were 'robotic assisted', 'ureteric reimplantation', 'cystoplasty', 'ileal conduit', 'neobladder', 'sacrocolpopexy', 'colposuspension', 'artificial urinary sphincter', 'genitourinary fistula' and 'posterior urethral stenoses'. We identified the latest available evidence in the use of robotic technology in specific FRNU procedures such as the reconstruction of the ureters, bladder and urinary sphincter, urinary diversion, and repair of genitourinary prolapse and fistula. We found that there is a lack of prospective studies to assess the robotic-assisted approach in the field of FRNU. Despite this, the advantages that robotic technology can bring to the field of FRNU are evident, including better ergonomics and visual field, less blood loss and shorter hospital stays. There is therefore a need for further prospective studies with larger patient numbers and longer follow-up periods to establish the reproducibility of these results and the long-term efficacy of the procedures, as well as the impact on patient outcomes. Common index procedures and a standardized approach to these procedures should be identified to enhance training.
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Affiliation(s)
- Hermione Tsoi
- Department of Urology, Royal Hallamshire Hospital, Glossop Rd, Broomhall, Sheffield S10 2JF, UK
| | | | - Mehmet Gokhan Culha
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | | | - François Hervé
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Tanja Hüesch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | | | - Véronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Tenon Academic Hospital, Sorbonne University, Paris, France
| | - Nadir I. Osman
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
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Yuanzhuo C, Liao P, Chi Z, Shuai X, Deyi L. Efficacy and Safety of Robot-assisted AUS Implantation Surgery in Treating Severe Stress Urinary Incontinence: A Systematic Review and Meta-Analysis. Urology 2023; 171:88-95. [PMID: 36223811 DOI: 10.1016/j.urology.2022.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the effectiveness and safety of robot-assisted artificial urinary sphincter (AUS) implantation surgery for female patients with severe stress urinary incontinences (SUI) by performing a systematic literature review. METHODS A comprehensive search was carried out across multiple databases, including PubMed, EMBASE, Web of Science Clarivate, Cochrane library, Medicine and clinicaltrials.gov between inception to March 2022. Studies were included if they met the inclusion criteria and were evaluated by different quality evaluation methods according to study types. P value and 95% confidence intervals (CI) of outcome measures mainly including continence rates, intraoperative and postoperative complication rates were pooled to present the efficacy and safety. RESULTS A total of 9 studies with 157 participants were finally included. Eight retrospective and 1 prospective study met the inclusion criteria with moderate and high evidence levels. The pooled results showed that patients with robot-assisted AUS implantation treatment, presented great continence rate (P = .83, 95%CI:0.76-0.89) but high complication rate (Intraoperation: 0.21 95%CI:0.11-0.34; Postoperation: 0.20 95%CI: 0.12-0.29). In addition, subgroup analysis of 2 approaches showed that compared with the posterior approach, the traditional surgical approach had better efficacy and safety. CONCLUSION The results of this study indicated that robot-assisted AUS implantation surgery improved SUI patients' urinary continence, but the complication rates were high, which mainly included intraoperative vaginal and bladder injury and postoperative acute urinary retention. More evidence from prospective studies is needed to provide guidance for clinical practice.
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Affiliation(s)
- Chen Yuanzhuo
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Peng Liao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhang Chi
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Xu Shuai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Luo Deyi
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
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Phe V, Pignot G, Legeais D, Bensalah K, Mathieu R, Lebacle C, Madec FX, Doizi S, Irani J. Les complications chirurgicales en urologie adulte : chirurgie du pelvis et du périnée. Prog Urol 2022; 32:977-987. [DOI: 10.1016/j.purol.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022]
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Chartier-Kastler E, Guillot-Tantay C, Ruggiero M, Cancrini F, Vaessen C, Phé V. Outcomes of robot-assisted urinary sphincter implantation for male neurogenic urinary incontinence. BJU Int 2021; 129:243-248. [PMID: 34174147 DOI: 10.1111/bju.15528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To report the functional outcomes of robot-assisted laparoscopic artificial urinary sphincter implantation (R-AUS) in men with neurogenic stress urinary incontinence (SUI). PATIENTS AND METHODS A monocentric retrospective study included all consecutive adult male neuro-urological patients who underwent R-AUS for SUI between January 2011 and August 2018. The AUS was implanted via a transperitoneal robot-assisted laparoscopic approach. Intraoperative and early postoperative complications were reported (Clavien-Dindo classification). Continence was defined as no pad usage. Revision and explantation rates were also evaluated. RESULTS Overall, 19 men with a median (interquartile range [IQR]) age of 45 (37-54) years were included. No conversion to laparotomy was needed. Three minor (Clavien-Dindo Grade I-II) early postoperative complications occurring in three (15.8%) patients were reported. The median (IQR) follow-up was 58 (36-70) months. At the end of the follow-up, the continence rate was 89.5%. The AUS revision and explantation rates were 5.3% and 0%, respectively. CONCLUSION A R-AUS is a safe and efficient procedure for AUS implantation in adult male neuro-urological patients, referring to the challenging open technique.
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Affiliation(s)
- Emmanuel Chartier-Kastler
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne Université Medical School, Paris, France
| | - Cyrille Guillot-Tantay
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne Université Medical School, Paris, France
| | - Marina Ruggiero
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne Université Medical School, Paris, France
| | - Fabiana Cancrini
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne Université Medical School, Paris, France.,Department of Medical and Surgical Sciences and Translational Medicine, Sant 'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Christophe Vaessen
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne Université Medical School, Paris, France
| | - Véronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne Université Medical School, Paris, France
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Broudeur L, Loubersac T, Le Normand L, Karam G, Branchereau J, Rigaud J, Perrouin-Verbe MA. New technique of robot-assisted laparoscopic artificial urinary sphincter implantation in female by a posterior approach with intraoperative cystoscopic monitoring. World J Urol 2021; 39:4221-4226. [PMID: 34050814 DOI: 10.1007/s00345-021-03739-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report the early experience of a modified technique of robot-assisted artificial urinary sphincter (AUS) implantation in female, with a posterior approach to the bladder neck and intraoperative real-time cystoscopic monitoring. METHODS Retrospective monocentric study included all consecutive female who underwent a primary robot-assisted AUS implantation between 2017 and 2019. Real-time intraoperative cystoscopic monitoring was carried out to check the correct level of the dissection and to avoid any injury during bladder neck dissection. Perioperative and intraoperative data, functional outcomes and complications were assessed. Continence was defined as 0 to 1 pad per day. RESULTS Twenty-four patients were included, the median age was 66 years, 23/24 (96%) had previous SUI or prolapse surgery. Two conversions to open surgery and 2 modifications of the surgical technique with anterior dissection of the bladder neck were required due to major vesicovaginal adhesions. Overall, 20 patients underwent the robotic posterior approach. Eleven intraoperative complications in 10 patients (50%) occurred, including 7 bladder injuries 4 vaginal injuries, without the need to stop the procedure. The median hospital stay was 3 days (2-7). One AUS was removed at 1 year due to vaginal erosion. At last follow-up (median 26 months (22-36)), 95% of the devices were in place and activated and the continence rate was 84%. CONCLUSIONS Early functional results of robot-assisted AUS implantation with a posterior approach to the bladder neck and intraoperative cystoscopic monitoring are promising despite the high rate of intraoperative complications due to previous surgeries. Further evaluation of this technique is required.
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Affiliation(s)
- L Broudeur
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France.
| | - T Loubersac
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - L Le Normand
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - G Karam
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - J Branchereau
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - J Rigaud
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - M A Perrouin-Verbe
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
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Ruiz-Hernández M, López-Fando L, Sánchez-Guerrero C, Sánchez-González Á, Artiles-Medina A, Santiago-González M, Jiménez-Cidre MÁ, Burgos-Revilla FJ. Combined laparoscopic surgery for the treatment of pelvic organ prolapse and recurrent urinary incontinence. Actas Urol Esp 2021; 45:160-166. [PMID: 33308857 DOI: 10.1016/j.acuro.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/06/2020] [Accepted: 09/06/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Laparoscopic sacral colpopexy (LSC) is the gold standard treatment for apical pelvic organ prolapse (POP). Artificial urinary sphincter (AUS) has a high success rate in treating recurrent stress urinary incontinence (SUI). OBJECTIVE To describe the first simultaneous LSC and AUS implantation through a vesicovaginal approach to the bladder neck. MATERIAL AND METHODS Operation is performed through a transperitoneal approach. The rectovaginal space is created and the posterior mesh is fixed. The vesicovaginal and both laterovesical spaces are dissected. The vesicovaginal space is connected to both lateral spaces. This is main step of the procedure because it let us place the cuff around the bladder neck in a non-blind fashion. The anterior mesh is fixed to the vagina. The anterior side of the bladder neck is dissected and the cuff implanted. Both meshes are fixed to the promontory. Pressure-regulating balloon is inserted, the pump is placed in the labia majora and the components are connected. Peritoneum is closed. RESULTS Surgical time was 180 minutes, bladder catheter was removed at 5th postoperative day, hospital stay was 5 days. The AUS was activated 6 weeks after surgery. No perioperative complications occurred. After 12 months the patient is pad-free and prolapse was objectively and subjectively cured. CONCLUSIONS Vesicovaginal dissection is a shared step in this technique of LSC and AUS implantation. This approach could minimize the risk of bladder neck injury. We propose this technique in selected cases of prolapse and recurrent SUI.
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Affiliation(s)
- M Ruiz-Hernández
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España.
| | - L López-Fando
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Sánchez-Guerrero
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España
| | - Á Sánchez-González
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España
| | - A Artiles-Medina
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - M Á Jiménez-Cidre
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España
| | - F J Burgos-Revilla
- Servicio de Urología. Hospital Universitario Ramón y Cajal, Madrid, España
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14
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Schroeder A, Munier P, Saussine C, Tricard T. Outcomes of laparoscopic artificial urinary sphincter in women with stress urinary incontinence: mid-term evaluation. World J Urol 2021; 39:3057-3062. [PMID: 33388876 DOI: 10.1007/s00345-020-03527-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/09/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Although artificial urinary sphincter (AUS) has become an established treatment for moderate to severe stress urinary incontinence (SUI), implantation can be challenging. This study aimed to review the outcomes of laparoscopic AUS (LAUS) implantation and revision in women presenting with SUI. METHODS We reviewed the files of female patients presenting with moderate to severe SUI treated with LAUS implantation from October 2007 to July 2017. Surgeries were performed by one surgeon experienced in open AUS implantation and starting LAUS implantation. The primary endpoint was postoperative urinary continence, which was divided into three categories: complete continence, improved continence, and unchanged incontinence. The secondary outcomes were complications, explantation-free and revision-free time. RESULTS A total of 49 women (mean age 64 years, range 40-80) had LAUS implantation. Among the 42 patients (85.7%) with an AUS in place at the last follow-up, 25 (59.5%) were fully continent, 16 (38.1%) had improved continence, and 1 (2.4%) had unchanged incontinence. At the last follow-up, 29 (59.2%) patients had their initial AUS and 13 (26.5%) had at least one reintervention. There were 9 (18.4%) intraoperative complications and 25 (51%) postoperative complications, of which 9 (18.4%) were Clavien⩾3. After a median follow-up of 4 years, 9 (18.4%) explantations and 11 (22.5%) revisions occurred. The average period without explantation or revision was 3.7 and 3.1 years, respectively. CONCLUSION Our study shows that the laparoscopic approach for AUS implantation is an efficient treatment option for women with moderate to severe SUI.
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Affiliation(s)
- Alice Schroeder
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg 1 Place de L'Hôpital, 67000, Strasbourg, France.
| | - Pierre Munier
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Christian Saussine
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Thibault Tricard
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg 1 Place de L'Hôpital, 67000, Strasbourg, France
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15
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Peyronnet B, Gray G, Capon G, Cornu JN, Van Der Aa F. Robot-assisted artificial urinary sphincter implantation. Curr Opin Urol 2021; 31:2-10. [PMID: 33239514 DOI: 10.1097/mou.0000000000000837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of the present manuscript was to provide an overview on the current state of robotic artificial urinary sphincter (AUS) implantation in male and female patients. RECENT FINDINGS Over the past few years, several series have been reported, with promising outcomes for the most part. This has contributed to expand the use of bladder neck AUS, especially in female patients, which was, until then, hampered by its perioperative morbidity. SUMMARY Robotic AUS has been developed to overcome the technical challenge of bladder neck implantation in female patients and in specific male subgroups, especially self-catheterizing neurological patients. All the series of robotic AUS implantation published in the past few years reported much lower rates of cuff erosion and AUS explantation than the historical open cohorts suggesting that the robotic approach might become the standard for female AUS implantation. This less morbid approach along with technological improvement of the AUS device may contribute to make it a more popular option in the treatment of female stress urinary incontinence due to intrinsic sphincter deficiency. There are much less data available on robotic bladder neck AUS implantation in male patients.
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Affiliation(s)
| | - Gary Gray
- Department of Urology, University of Alberta, Edmonton, Canada
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Chung E. Artificial urinary sphincter surgery in the special populations: neurological, revision, concurrent penile prosthesis and female stress urinary incontinence groups. Asian J Androl 2020; 22:45-50. [PMID: 31793444 PMCID: PMC6958990 DOI: 10.4103/aja.aja_128_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The artificial urinary sphincter (AUS) remains the standard of care in men with severe stress urinary incontinence (SUI) following prostate surgery and radiation. While the current AUS provides an effective, safe, and durable treatment option, it is not without its limitations and complications, especially with regard to its utility in some “high-risk” populations. This article provides a critical review of relevant publications pertaining to AUS surgery in specific high-risk groups such as men with spinal cord injury, revision cases, concurrent penile prosthesis implant, and female SUI. The discussion of each category includes a brief review of surgical challenge and a practical action-based set of recommendations. Our increased understandings of the pathophysiology of various SUI cases coupled with effective therapeutic strategies to enhance AUS surgery continue to improve clinical outcomes of many patients with SUI.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, QLD 4000, Australia.,University of Queensland, Princess Alexandra Hospital, Brisbane, QLD 4000, Australia.,Macquarie University Hospital, Sydney, NSW 2109, Australia
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17
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Peyronnet B, Greenwell T, Gray G, Khavari R, Thiruchelvam N, Capon G, Ockrim J, Lopez-Fando L, Gilleran J, Fournier G, Van Koeveringe GA, Van Der Aa F. Current Use of the Artificial Urinary Sphincter in Adult Females. Curr Urol Rep 2020; 21:53. [PMID: 33098485 DOI: 10.1007/s11934-020-01001-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW The aim of the present report was to review the recent evidences regarding the use of artificial urinary sphincter (AUS) in adult females. RECENT FINDINGS While the excellent functional outcomes of AUS in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) have been reported for decades, its use has remained confidential in most countries likely due to its challenging implantation and inherent morbidity. Over the past few years, laparoscopic and, more recently, robotic techniques of AUS implantation in female patients have been described with promising perioperative outcomes. As a result, the use of AUS has increased in several countries. The indications are mostly recurrent or persistent SUI after previous anti-incontinence procedures and neurogenic SUI. Owing to its unique potential to restore continence while maintaining low outlet resistance during the voiding phase, AUS may be of special interest in female patients with detrusor underactivity. High level of evidence data from trials which are underway, along with developments in robotic surgery and technological refinements of the device, may well, almost 50 years after its introduction, give to the AUS its momentum as a major contributor in the female SUI armamentarium. While the use of AUS in female patients has been restricted to some countries and a few high-volume centers, it has started spreading again over the past few years, thanks to the rise of minimally invasive approaches which facilitate its implantation, and this is yielding promising outcomes.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, University of Rennes, Rennes, France. .,Service d'Urologie, Hopital Pontchaillou, 2 rue Henri Le Guilloux, 35000, Rennes, France.
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Gary Gray
- Department of Urology, University of Alberta, Edmonton, Canada
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | | | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Jeremy Ockrim
- Department of Urology, University College London Hospital, London, UK
| | - Luis Lopez-Fando
- Department of Urology, University Hospital Ramon y Cajal, Madrid, Spain
| | - Jason Gilleran
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, USA
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Kim A, Kim S, Kim HG. Current Overview of Surgical Options for Female Stress Urinary Incontinence. Int Neurourol J 2020; 24:222-230. [PMID: 33017893 PMCID: PMC7538288 DOI: 10.5213/inj.2040052.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023] Open
Abstract
Stress urinary incontinence (SUI) is a highly prevalent health condition that significantly impacts the quality of life. Traditional methods of treatment for SUI, such as pubovaginal sling and Burch colposuspension, have been replaced by the midurethral sling because of its high efficacy, low complication and morbidity rates, and short learning curve. Although multiple behavioral and operative treatments exist, midurethral slings are the gold standard for the treatment of SUI in women. However, several reports have raised concerns about complications caused by the synthetic mesh used in midurethral slings. Therefore, surgical treatment for SUI in women must be chosen with care, taking into account potential complications. Herein, we review the current safety issues pertaining to the use of meshes, the efficacy of traditional surgeries, old and new midurethral slings, and recent data comparing the efficacy and safety of different surgical options. This review is aimed at developing practical guidelines for choosing surgical options for women with SUI.
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Affiliation(s)
- Aram Kim
- Department of Urology, KonKuk University Medical Center, KonKuk University School of Medicine, Seoul, Korea
| | - Sehwan Kim
- Department of Biomedical Engineering, Beckman Laser Institute Korea, School of Medicine, Dankook University, Cheoan, Korea
| | - Hyeong Gon Kim
- Department of Urology, KonKuk University Medical Center, KonKuk University School of Medicine, Seoul, Korea
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Chartier-Kastler E, Vaessen C, Rouprêt M, Bassi S, Cancrini F, Phé V. Robot-assisted laparoscopic artificial urinary sphincter insertion in women with stress urinary incontinence: a pilot single-centre study. BJU Int 2020; 126:722-730. [PMID: 32558978 DOI: 10.1111/bju.15147] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the functional outcomes of robot-assisted laparoscopic artificial urinary sphincter (AUS; AMS 800™, American Medical Systems, Minnetonka, MN, USA) implantation and revision in women with stress urinary incontinence (SUI). PATIENTS AND METHODS A pilot prospective monocentric study included all consecutive female patients with SUI and undergoing an AUS surgery (implantation or revision) using a robotic approach between 2012 and 2018. The AUS was implanted through a transperitoneal robotic approach. The dissection of the bladder neck was initiated using a posterior approach with a permanent visual control. Intraoperative and early postoperative complications were reported (Clavien-Dindo classification). Continence was defined as no pad usage. RESULTS A total of 41 patients, median (interquartile range [IQR]) age 67.5 (57-74.7) years were included. In the group of 27 patients undergoing an AUS implantation, one conversion to laparotomy, one bladder neck and one ureteric injury occurred. The AUS was not implanted in the two latest cases. Twelve minor (Clavien-Dindo Grade I-II) early postoperative complications occurring in 10 patients were reported. The median (IQR) follow-up was 19 (11-27) months. The continence rate was 84% (21/25 patients). In the group of 14 patients undergoing an AUS revision, no vaginal or bladder injury was reported. One patient had a bowel injury with conversion to laparotomy without AUS insertion. Two major (Clavien-Dindo Grade III-V) early postoperative complications occurred in two patients: one intraoperative bowel injury, which ultimately resulted in the death of the patient and one device infection requiring an explantation of the AUS. The median (IQR) follow-up was 18 (13.5-24.2) months. The continence rate was 83.3% (10/12 patients). CONCLUSION The results obtained after robot-assisted laparoscopic AUS implantation among women are promising despite the significant morbidity due to previous pelvic surgeries. Longer follow-up studies are needed.
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Affiliation(s)
- Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris,, France
| | - Christophe Vaessen
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris,, France
| | - Morgan Rouprêt
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris,, France
| | - Silvia Bassi
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris,, France.,Urology, Sant'Andrea Hospital, Università degli Studi "La Sapienza" di Roma, Roma, Italy
| | - Fabiana Cancrini
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris,, France.,Department of Urology, University of Verona, Verona, Italy
| | - Veronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris,, France
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Reus CR, Phé V, Dechartres A, Grilo NR, Chartier-Kastler EJ, Mozer PC. Performance and Safety of the Artificial Urinary Sphincter (AMS 800) for Non-neurogenic Women with Urinary Incontinence Secondary to Intrinsic Sphincter Deficiency: A Systematic Review. Eur Urol Focus 2020; 6:327-338. [DOI: 10.1016/j.euf.2018.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/02/2018] [Accepted: 10/10/2018] [Indexed: 01/11/2023]
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21
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Joint Report on Terminology for Surgical Procedures to Treat Stress Urinary Incontinence in Women. Female Pelvic Med Reconstr Surg 2020; 26:162-172. [PMID: 32079836 DOI: 10.1097/spv.0000000000000831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Standardized terminology for surgical procedures commonly performed to treat stress urinary incontinence in women is needed to facilitate research, clinical care, and teaching in female pelvic medicine and reconstructive surgery. METHODS This report combines the input of members of the American Urogynecologic Society and the International Urogynecological Association, assisted by external referees. Extensive searches of the literature were performed, including Instructions for Use brochures and original source documents where possible. Historical context was considered along with procedural modifications, and expert opinion was included when appropriate. RESULTS A terminology report for the procedures commonly performed to treat stress urinary incontinence in women was produced. Included procedures are midurethral sling, retropubic colposuspension, pubovaginal sling, urethral bulking, and artificial urinary sphincter. Appropriate figures have been included to supplement and help clarify the text. Ongoing review will be performed periodically to keep the document updated and widely acceptable. CONCLUSIONS This document is a literature and consensus-based terminology report for surgical procedures to treat stress urinary incontinence in women. Future publications in female pelvic medicine and reconstructive surgery should use this standardized terminology whenever possible.
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Joint report on the terminology for surgical procedures to treat stress urinary incontinence in women. Int Urogynecol J 2020; 31:465-478. [DOI: 10.1007/s00192-020-04237-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Outcomes of artificial urinary sphincter in female with neurological stress urinary incontinence: a long-term follow-up. World J Urol 2020; 39:157-162. [PMID: 32052128 DOI: 10.1007/s00345-020-03105-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/22/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To report the outcomes of AUS in women with neurological SUI resulting from intrinsic sphincter deficiency after a follow-up from 3 to 20 years. METHODS The charts of female with moderate to severe neurological SUI who underwent open or laparoscopic AUS implantation between November 1994 and July 2014 were reviewed retrospectively. All patients were operated by a single experienced surgeon. Primary endpoint was a postoperative continence categorized as complete continence (no pads used), improved incontinence or unchanged incontinence. RESULTS Twenty-three women (mean age 54 years, range 19-77) underwent open or laparoscopic AUS implantation. At the last follow-up, 7 (30.4%) initial artificial urinary sphincters remained in situ and 9 (39.1%) patients had at least one revision or reimplantation. Sixteen patients were fully continent (69.6%), four (17.4%) had improved incontinence and three (13.0%) had unchanged incontinence. After a median follow-up of 11.6 years (3-22), 8 (34.8%) explanations in 7 patients and 16 (69.6%) revisions in 11 patients occurred. The average time without explanation or revision was 10.9 and 8.5 years, respectively. Survival rates without AUS explanation were 94.4%, 76.5%, 72.8%, 50% and without revision were 83.3%, 64.7%, 45.5% and 16.7% at 5, 10, 15 and 20 years, respectively. CONCLUSION Although all methods are imperfect at best, AUS remain toward our experience a good way to achieve long-term continence in female patients suffering from neurological SUI with preserved manual dexterity.
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Barakat B, Franke K, Hijazi S, Schakaki S, Gauger U, Hasselhof V, Vögeli TA. A systematic review and meta-analysis of clinical and functional outcomes of artificial urinary sphincter implantation in women with stress urinary incontinence. Arab J Urol 2020; 18:78-87. [PMID: 33029411 PMCID: PMC7473178 DOI: 10.1080/2090598x.2020.1716293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/21/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the complications and results of artificial urinary sphincter (AUS) implantation in women with stress urinary incontinence (SUI). METHODS A selective database search using keywords (1990-2019) was conducted to validate the effectiveness of the AUS in women. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilised. The meta-analysis included 964 women (15 studies) with persistent SUI. The Newcastle-Ottawa score was used to determine the quality of the evidence in each study. The success rate and complications associated with the AUS were analysed. RESULTS Meta-analysis of the published studies showed that complete continence was achieved at a mean rate of 79.6% (95% confidence interval [CI] 72.2-86.6%) and a significant improvement was achieved in 15% (95% CI 10-25%). The mean (range) follow-up was 22 (6-204) months. The mean number of patients per study was 68. The mean (range) explantation rate was 13 (0-44)%. Vaginal erosion occurred in a mean (range) of 9 (0-27)% and mechanical complications in 13 (0-47)%. Infections accounted for 7% of the complications. The total mean (range) revision rate of the implanted AUS was 15.42 (0-44)%. The mean (range) size of the cuff used was 6.7 (5-10) cm. CONCLUSION Our present analysis showed that implantation of an AUS in women with severe UI is an effective treatment option after failure of first-line therapy. However, the currently available study population is too small to draw firm conclusions. ABBREVIATIONS AMS: American Medical Systems; AUS: artificial urinary sphincter; EAU: European Association of Urology; LE: Level of Evidence; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; QoL: quality of life; SHELTER: Services and Health for Elderly in Long TERm care (study); SUI: (stress) urinary incontinence.
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Affiliation(s)
- Bara Barakat
- Department of Urology and Pediatric Urology, Hospital Viersen, Viersen, Germany
| | - Knut Franke
- Department of Urology and Pediatric Urology, Hospital Viersen, Viersen, Germany
| | - Sameh Hijazi
- Department of Urology, Hospital Ibbenbüren, Ibbenbüren, Germany
| | - Samer Schakaki
- Department of Urology, Hospital Osnabrück, Osnabrück, Germany
| | | | | | - Thomas-Alexander Vögeli
- Department of Urology and Pediatric Urology, University Hospital RWTH Aachen, Aachen, Germany
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Tricard T, Jochum F, Bergerat S, Munier P, Schroeder A, Saussine C. Outcomes of open artificial urinary sphincter in women with stress urinary incontinence: long-term follow up. Ther Adv Urol 2019; 11:1756287219874676. [PMID: 31555345 PMCID: PMC6747852 DOI: 10.1177/1756287219874676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/17/2019] [Indexed: 11/25/2022] Open
Abstract
Background: The aim of this study was to report the outcomes of artificial urinary sphincter (AUS) in women with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency after a follow up of 10 years. Methods: The charts of female patients with moderate-to-severe SUI who underwent open AUS implantation between November 1994 and April 2007 were reviewed retrospectively. All patients were operated on by a single experienced surgeon through an open retropubic approach with systematic bladder incision. Primary endpoint was postoperative continence categorized as complete continence (no pads used), improved incontinence, or unchanged incontinence. Results: A total of 63 women (mean age: 58 years, range: 17–82) underwent open AUS implantation. There were seven (11.1%) intraoperative complications. At the last follow up, 26 (41.3%) initial AUSs remained in situ and 21 (33.3%) patients had at least one revision or reimplantation. Of these 47 patients (74.6%), 35 (74.5%) were fully continent, 3 (6.4%) had improved incontinence, and 9 (19.1%) had unchanged incontinence. A total of 20 patients (31.7%) experienced postoperative complications, but only 2 (3.2%) were Clavien ⩾3. After a median follow up of 14 ± 6 years, 20 (31.7%) explantations and 29 (46%) revisions occurred. The average time without explantation or revision was 11.6 and 9 years, respectively. Conclusions: In our experience, AUS is a good option for women with moderate to severe SUI, with good long-term outcomes.
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Affiliation(s)
- Thibault Tricard
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Floriane Jochum
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 place de l'Hôpital, Strasbourg, France
| | - Sébastien Bergerat
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 place de l'Hôpital, Strasbourg, France
| | - Pierre Munier
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 place de l'Hôpital, Strasbourg, France
| | - Alice Schroeder
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 place de l'Hôpital, Strasbourg, France
| | - Christian Saussine
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 place de l'Hôpital, Strasbourg, France
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Gondran-Tellier B, Boissier R, Baboudjian M, Rouy M, Gaillet S, Lechevallier E, Michel F, Karsenty G. Robot-assisted implantation of an artificial urinary sphincter, the AMS-800, via a posterior approach to the bladder neck in women with intrinsic sphincter deficiency. BJU Int 2019; 124:1077-1080. [PMID: 31365772 DOI: 10.1111/bju.14884] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe a new technique for robot-assisted AMS-800 artificial urinary sphincter (AUS) bladder neck implantation in women. PATIENTS AND METHODS We reviewed the medical files of patients who underwent robot-assisted AUS implantation between March 2017 and November 2018 at our centre. All of the implantations were performed using a posterior approach to the bladder neck in order to avoid blind dissection and the risk of vaginal and/or bladder injury. This strategy was viewed as an alternative to the anterior robot-assisted implantation recently described. The AUSs were activated 5 weeks after implantation. Patients were followed up at 3, 6 and 12 months, then annually. RESULTS Eight patients, with a median age of 64 years, underwent robot-assisted AUS implantation via a posterior approach to the bladder neck. The median preoperative pad weight was 300 g/24 h. The median operating time was 244 min. No peri-operative vaginal and or bladder injuries were observed. At a median of 12 months of follow-up, all the AUSs were functional. Five patients required no protection (62.5%), three had day protection (37.5%), and all said they were satisfied except for one patient (12.5%) who requested treatment for persistent urge incontinence. CONCLUSION Robot-assisted AUS implantation in women via a posterior approach to the bladder neck is a procedure that is simple, reproducible and safe. The short-term functional results are satisfactory and comparable to those obtained via an open approach. A more long-term comparison of the efficacy and longevity of AUSs implanted using this posterior approach is needed to confirm its benefit compared with the anterior robot-assisted approach and the classic open technique.
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Affiliation(s)
- Bastien Gondran-Tellier
- Urology and Kidney Transplantation Department, La Conception Hospital, Aix Marseille University, Marseille, France
| | - Romain Boissier
- Urology and Kidney Transplantation Department, La Conception Hospital, Aix Marseille University, Marseille, France
| | - Michael Baboudjian
- Urology and Kidney Transplantation Department, La Conception Hospital, Aix Marseille University, Marseille, France
| | - Mathieu Rouy
- Urology and Kidney Transplantation Department, La Conception Hospital, Aix Marseille University, Marseille, France
| | - Sarah Gaillet
- Urology and Kidney Transplantation Department, La Conception Hospital, Aix Marseille University, Marseille, France
| | - Eric Lechevallier
- Urology and Kidney Transplantation Department, La Conception Hospital, Aix Marseille University, Marseille, France
| | - Floriane Michel
- Urology and Kidney Transplantation Department, La Conception Hospital, Aix Marseille University, Marseille, France
| | - Gilles Karsenty
- Urology and Kidney Transplantation Department, La Conception Hospital, Aix Marseille University, Marseille, France
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Sussman RD, Peyronnet B, Brucker BM. The current state and the future of robotic surgery in female pelvic medicine and reconstructive surgery. Turk J Urol 2019; 45:331-339. [PMID: 31509506 DOI: 10.5152/tud.2019.19068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 12/12/2022]
Abstract
In this article, we review the current uses and future directions of robotic surgery in the field of female pelvic medicine and reconstructive surgery. Pelvic surgery is ideal for the use of surgical robots, which provide improved visualization and ease of suturing deep within the pelvis. Robots have been successfully used for the treatment of pelvic organ prolapse, in procedures such as sacrocolpopexy, sacrohysteropexy, and uterosacral ligament plication. Surgeons have used the robotic successfully to treat various etiologies of female pelvic pain including fibroids, endometriosis, and nerve entrapment. Robotic repair of iatrogenic injury has been described with excellent outcomes and avoidance of conversion to open surgery in the event of an injury caused using the robotic platform. While more data is needed on this topic, there has been increasing interest in using the robot for urologic reconstruction including repair of vesico-vaginal fistula, cystectomy, augmentation cystoplasty, and continent and non-continent diversions. Recently the use of the robot has been described in the treatment of stress urinary incontinence in females, with robotic placement of an artificial urinary sphincter. While robotic surgery is associated with increased cost, the outcomes of robotic surgery in female urology are promising. More studies that properly evaluate the benefits of robotic surgery as compared to open and laparoscopic approaches are needed.
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Abstract
There have been several recent developments in surgical treatments for male and female incontinence. This article reviews the current options for treatments of urge and stress incontinence in men and women. Treatments for urge incontinence discussed include intradetrusor onabotulinum toxin A, sacral neuromodulation and percutaneous tibial nerve stimulation. For stress incontinence, suburethral mesh, bulking agents, autologous slings, colposuspension, male slings and artificial urinary sphincters are assessed.
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Affiliation(s)
- Alison Downey
- Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
| | - Richard D Inman
- Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
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Kourbanhoussen K, Cecchi M, Chevrot A, Costa P, Droupy S, Wagner L. Sphincter urinaire artificiel robot chez la femme : début d’expérience. Prog Urol 2019; 29:371-377. [DOI: 10.1016/j.purol.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
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Robotic Surgery as Applied to Functional and Reconstructive Urology. Eur Urol Focus 2019; 5:322-328. [DOI: 10.1016/j.euf.2019.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 11/19/2022]
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Implantation du sphincter artificiel AMS 800® chez la femme par cœlioscopie robot-assistée : expérience monocentrique. Prog Urol 2019; 29:246-252. [DOI: 10.1016/j.purol.2018.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/19/2018] [Accepted: 12/15/2018] [Indexed: 11/17/2022]
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Sihra N, Kujawa M, Solomon E, Harding C, Sahai A, Malde S. Female stress urinary incontinence MDT. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818821548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The management of female stress urinary incontinence (SUI) has come under scrutiny in recent years following growing reports of mesh-related complications. Patients require thorough evaluation and management as part of a multidisciplinary team, and extensive counselling about the surgical treatment options is imperative. There is no clear consensus on the optimal management of the complex group of patients with mesh-related complications or recurrent SUI. We present two cases of female SUI to highlight the key factors to be considered when managing these patients. Level of evidence: Level 5.
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Affiliation(s)
- Néha Sihra
- Department of Urology, St George’s Hospital, London, UK
| | - Magda Kujawa
- Department of Urology, Stockport NHS Foundation Trust, Stepping Hill Hospital, UK
| | - Eskinder Solomon
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
| | | | - Arun Sahai
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
| | - Sachin Malde
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
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Ruiz-Hernández M, López-Fando L, Gómez de Vicente JM, Jiménez-Cidre MA, Sánchez-Gallego MD, Lorca-Álvaro J, Díaz-Pérez D, Burgos-Revilla FJ. A new approach to laparoscopic implantation of the artificial urinary sphincter: Vesicovaginal approach to the bladder neck. Actas Urol Esp 2019; 43:44-50. [PMID: 30064705 DOI: 10.1016/j.acuro.2018.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The artificial urinary sphincter (AUS) is not used extensively in the treatment of female urinary stress incontinence (USI) due to the poor reproducibility of the techniques used. We describe a new approach to laparascopic implantation, of which dissection of the vesicovaginal space is an essential step. This enables an approach under direct vision to the posterior surface of the bladder neck. MATERIAL AND METHODS We present two cases where this approach was used. A transperitoneal approach was made in the Trendelenburg position. The main steps were: creating the vesicovaginal space until identifying the bladder neck, creating two laterovesical spaces, communicating these with the vesicovaginal space, and dissecting the anterior surface of the bladder neck, attempting to preserve the pubovesical ligament. The cuff and reservoir were inserted through the 12mm infraumbilical trocar. The connections were externalised through a left suprapubic incision and a subcutaneous tunnel created up to the labia majora where the activation pump was placed. The procedure was completed with closure of the peritoneum. It is essential to use a vaginal valve to facilitate dissection. RESULTS Surgery time: 140 and 135minutes, with no intraoperative complications. After removing the urinary catheter, one patient had elevated postvoid residual urine volume, which was managed conservatively. Hospital stay: 72h. At 3 and 9 months the patients were fully continent. CONCLUSIONS We present the preliminary results of laparoscopic implantation of an AUS through a vesicovaginal approach to the posterior surface of the bladder neck, which might reduce potential complications that have been observed after the routine techniques.
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Affiliation(s)
- M Ruiz-Hernández
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España.
| | - L López-Fando
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - J M Gómez de Vicente
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - M A Jiménez-Cidre
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - M D Sánchez-Gallego
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - J Lorca-Álvaro
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - D Díaz-Pérez
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - F J Burgos-Revilla
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
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Zhao Y, Gray G, Martin BS. Techniques - Robotic-assisted laparoscopic implantation of artificial urinary sphincter with concomitant hysterectomy and sacrocolpopexy. Can Urol Assoc J 2018; 13:E232-E234. [PMID: 30475690 DOI: 10.5489/cuaj.5580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Gary Gray
- University of Alberta, Edmonton, AB, Canada
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Peyronnet B, O'Connor E, Khavari R, Capon G, Manunta A, Allue M, Hascoet J, Nitti VW, Gamé X, Gilleran J, Castro-Sader L, Cornu JN, Waltregny D, Ahyai S, Chung E, Elliott DS, Fournier G, Brucker BM. AMS-800 Artificial urinary sphincter in female patients with stress urinary incontinence: A systematic review. Neurourol Urodyn 2018; 38 Suppl 4:S28-S41. [PMID: 30298943 DOI: 10.1002/nau.23833] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/26/2018] [Indexed: 11/06/2022]
Abstract
AIMS To perform a systematic review of studies reporting the outcomes of AMS-800 artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency (ISD). METHODS A systematic literature search of the Medline and Embase databases was performed in June 2018 in accordance with the PRISMA statement. No time limit was used. The protocol was registered in PROSPERO (CRD42018099612). Study selection and data extraction were performed by two independent reviewers. RESULTS Of 886 records screened, 17 were included. All were retrospective or prospective non-comparative case series. One study reported on vaginal AUS implantation, 11 on open AUS implantation, two on laparoscopic AUS implantation, two on robot-assisted AUS implantation and one compared open and robot-assisted implantations. The vast majority of patients had undergone at least one anti-incontinence surgical procedure prior to AUS implantation (69.1-100%). The intraoperative bladder neck injury rates ranged from 0% to 43.8% and the intraoperative vaginal injury rates ranged from 0 to 25%. After mean follow-up periods ranging from 5 to 204 months, the complete continence rates ranged from 61.1% to 100%. The rates of explantation, erosion and mechanical failure varied from 0% to 45.3%, 0% to 22.2% and 0% to 44.1%, respectively. CONCLUSIONS AMS-800 AUS can provide excellent functional outcomes in female patients with SUI resulting from ISD but at the cost of a relatively high morbidity. High level of evidence studies are needed to help better define the role of AUS in the female SUI armamentarium.
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Affiliation(s)
| | - Eabhann O'Connor
- Department of Urology, Galway University Hospital, Galway, Ireland
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, Texas
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Andrea Manunta
- Department of Urology, University of Rennes, Rennes, France
| | - Marta Allue
- Department of Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Victor W Nitti
- Department of Urology, New York University, New York, New York
| | - Xavier Gamé
- Department of Urology, University of Toulouse, Toulouse, France
| | - Jason Gilleran
- Department of Urology, William Beaumont Hospital, Royal Oak, Michigan
| | - Luis Castro-Sader
- Department of Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - David Waltregny
- Department of Urology, University Hospital of Liege, Liege, Belgium
| | - Sascha Ahyai
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Eric Chung
- Department of Urology, The University of Queensland, Brisbane, Australia
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Peyronnet B, Capon G, Belas O, Manunta A, Allenet C, Hascoet J, Calves J, Belas M, Callerot P, Robert G, Descazeaud A, Fournier G. Robot-assisted AMS-800 Artificial Urinary Sphincter Bladder Neck Implantation in Female Patients with Stress Urinary Incontinence. Eur Urol 2018; 75:169-175. [PMID: 30139632 DOI: 10.1016/j.eururo.2018.07.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/27/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Widespread adoption of the AMS-800 artificial urinary sphincter (AUS) in female patients has been hampered by the surgical morbidity of its implantation through an open approach. OBJECTIVE To describe a standardized technique of robotic bladder neck AUS implantation in female patients, and to report the perioperative and functional outcomes obtained by multiple surgeons with this technique. DESIGN, SETTINGS, AND PARTICIPANTS We retrospectively reviewed the charts of all female patients who underwent robotic AUS implantation for urinary incontinence due to intrinsic sphincter deficiency between March 2012 and March 2017 in five institutions. Most of the 10 surgeons involved were not highly experienced in female AUS implantation and/or in robotic surgery. SURGICAL PROCEDURE The AUS is implanted at the bladder neck through a transperitoneal robotic approach. The finger placed by the assistant surgeon in the vagina is paramount to expose the vesicovaginal space and guide the robotic surgeon throughout the bladder neck dissection. MEASUREMENTS The primary endpoint was the incontinence categorized as complete continence(ie, no pads used), improved incontinence, or unchanged incontinence. RESULTS AND LIMITATIONS Forty-nine female patients underwent a robotic AUS implantation. There were eight intraoperative complications (16.3%): five bladder neck injuries and three vaginal injuries. Nine patients experienced postoperative complications (18.3%), but only two were Clavien ≥3 (4.1%). After a median follow-up of 18.5 mo, one explantation (vaginal erosion, 2.1%) and three revisions (one mechanical and two nonmechanical failure, 6.1%) were needed. At last follow-up, 40 patients were fully continent (81.6%), six had improved incontinence (12.2%), and three had unchanged incontinence (6.1%). CONCLUSIONS In this first multicenter series of robot-assisted AUS implantation, our technique appeared feasible, safe, and reproducible with perioperative and functional outcomes in the early learning curve not inferior to those reported in large series of open AUS implantation from tertiary referral centers. PATIENT SUMMARY Robot-assisted bladder neck AMS-800 artificial urinary sphincter implantation in female patients with stress urinary incontinence resulting from intrinsic sphincter deficiency is feasible, safe, and reproducible with promising outcomes.
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Affiliation(s)
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Olivier Belas
- Department of Urology, Pole Santé Sud, Le Mans, France
| | - Andrea Manunta
- Department of Urology, University of Rennes, Rennes, France
| | - Clément Allenet
- Department of Urology, University of Bordeaux, Bordeaux, France
| | | | - Jehanne Calves
- Department of Urology, University of Brest, Brest, France
| | - Michel Belas
- Department of Urology, Pole Santé Sud, Le Mans, France
| | | | - Grégoire Robert
- Department of Urology, University of Bordeaux, Bordeaux, France
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Pal RP, Koupparis AJ. Expanding the indications of robotic surgery in urology: A systematic review of the literature. Arab J Urol 2018; 16:270-284. [PMID: 30147957 PMCID: PMC6105341 DOI: 10.1016/j.aju.2018.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 11/03/2022] Open
Abstract
Objectives To evaluate the recent developments in robotic urological surgery, as the introduction of robotic technology has overcome many of the difficulties of pure laparoscopic surgery enabling surgeons to perform complex minimally invasive procedures with a shorter learning curve. Robot-assisted surgery (RAS) is now offered as the standard for various surgical procedures across multiple specialities. Methods A systematic search of MEDLINE, PubMed and EMBASE databases was performed to identify studies evaluating robot-assisted simple prostatectomy, salvage radical prostatectomy, surgery for urolithiasis, distal ureteric reconstruction, retroperitoneal lymph node dissection, augmentation ileocystoplasty, and artificial urinary sphincter insertion. Article titles, abstracts, and full text manuscripts were screened to identify relevant studies, which then underwent data extraction and analysis. Results In all, 72 studies evaluating the above techniques were identified. Almost all studies were retrospective single-arm case series. RAS appears to be associated with reduced morbidity, less blood loss, reduced length of stay, and comparable clinical outcomes in comparison to the corresponding open procedures, whilst having a shorter operative duration and learning curve compared to the equivalent laparoscopic techniques. Conclusion Emerging data demonstrate that the breadth and complexity of urological procedures performed using the da Vinci® platform (Intuitive Surgical Inc., Sunnyvale, CA, USA) is continually expanding. There is a gaining consensus that RAS is producing promising surgical results in a wide range of procedures. A major limitation of the current literature is the sparsity of comparative trials evaluating these procedures.
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Key Words
- (L)(R)RP, (laparoscopic)(retropubic)radical prostatectomy
- (L)(RA) PN, (laparoscopic)(robot-assisted) partial nephrectomy
- (L-)(O-)(R-) RPLND, (laparoscopic)(open)(robot-assisted) retroperitoneal lymph node dissection
- (O)(L)(RA)SP, (open)(laparoscopic)(robot-assisted)simple prostatectomy
- (RA)RC, (robot-assisted) radical cystectomy
- (S)UI, (stress) urinary incontinence
- (s)RALP, (salvage)robot-assisted laparoscopic prostatectomy
- AUS, artificial urinary sphincter
- HoLEP, holmium laser enucleation of the prostate
- ICUD, intracorporeal urinary diversion
- LOS, length of hospital stay
- MIS, minimally invasive surgery
- PCNL, percutaneous nephrolithotomy
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- RAI, robot-assisted augmentation ileocystoplasty
- RAS, robot-assisted surgery
- RCT, randomised controlled trial
- RNL, robot-assisted nephrolithotomy
- RPL, robot-assisted pyelolithotomy
- Robot-assisted surgery
- Robotic surgery
- Urology
- sRRP, salvage RRP
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Affiliation(s)
- Raj P Pal
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Scott KA, Tonzi M, Nikolavsky D. Use of Artificial Urinary Sphincter and Slings to Manage Neurogenic Bladder Following Spinal Cord Injury—Is It Safe? CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chen YQ, Tao JW, Li L, Mao JB, Zhu CT, Lao JM, Yang Y, Shen LJ. Feasibility study on robot-assisted retinal vascular bypass surgery in an ex vivo porcine model. Acta Ophthalmol 2017; 95:e462-e467. [PMID: 28597519 DOI: 10.1111/aos.13457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/05/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe a new robot-assisted surgical system for retinal vascular bypass surgery (RVBS) and to compare the success rate with freehand RVBS. METHODS A robot-assisted system for retinal microsurgery was constructed to include two independent robotic arms. A 23-gauge light probe and an intraocular forceps were affixed to the arm end effectors to perform the intraocular manipulation. Harvested porcine eyes were introduced to be established animal models of closed-sky eyeballs after that pars plana vitrectomy using temporary keratoprosthesis was performed by a skilful surgeon. Retinal vascular bypass surgery (RVBS) was performed by an inexperienced ophthalmologist to test the ease of use. A stainless steel wire (45-μm pipe diameter) was used as an artificial vessel. Before RVBS, the wires were prepositioned at the retinal surface of the eyes. The Control group (n = 20) underwent freehand RVBS, and the Experimental group (n = 20) underwent robot-assisted RVBS. To create the simulated bypass, the distal end of the wire was inserted into the selected vessel and advanced ~4 mm away from the optic disc. If successful, then the proximal wire end was inserted and advanced ~2 mm towards the optic disc. The difference in the success rate for the freehand and robot-assisted procedures was analysed by the chi-square test. RESULTS The success rate for the freehand RVBS was 5% (1/20 eyes). In contrast, the robot-assisted success rate was 35% (7/20) of eyes (p < 0.05). CONCLUSION This study demonstrated the feasibility of robot-assisted RVBS in ex vivo porcine eyes. The robotic system increased the accuracy and stability of manipulation by eliminating freehand tremor, leading to a higher surgical success rate.
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Affiliation(s)
- Yi Qi Chen
- Eye Hospital of Wenzhou Medical University; Hangzhou Zhejiang China
- Wenzhou Medical University; Wenzhou Zhejiang China
| | - Ji Wei Tao
- Eye Hospital of Wenzhou Medical University; Hangzhou Zhejiang China
| | - Liang Li
- Wenzhou Medical University; Wenzhou Zhejiang China
| | - Jian Bo Mao
- Eye Hospital of Wenzhou Medical University; Hangzhou Zhejiang China
| | | | - Ji Meng Lao
- Wenzhou Medical University; Wenzhou Zhejiang China
| | - Yang Yang
- School of Mechanical Engineering and Automation; Beihang University; Beijing China
| | - Li-Jun Shen
- Eye Hospital of Wenzhou Medical University; Hangzhou Zhejiang China
- Wenzhou Medical University; Wenzhou Zhejiang China
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Gor RA, Elliott SP. Surgical Management of Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am 2017; 44:475-490. [DOI: 10.1016/j.ucl.2017.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Chen YQ, Tao JW, Su LY, Li L, Zhao SX, Yang Y, Shen LJ. Cooperative robot assistant for vitreoretinal microsurgery: development of the RVRMS and feasibility studies in an animal model. Graefes Arch Clin Exp Ophthalmol 2017; 255:1167-1171. [PMID: 28389702 DOI: 10.1007/s00417-017-3656-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/12/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The purpose of the study was to describe the development of a robotic aided surgical system named RVRMS (robotic vitreous retinal microsurgery system) and to evaluate the capability for using it to perform vitreoretinal surgery. METHODS The RVRMS was designed and built to include the key components of two independent arms. End-effectors of each arm fix various surgical instruments and perform intraocular manipulation. To evaluate properly the RVRMS, robot-assisted 23-gauge surgical tasks including endolaser for retinal photocoagulation, pars plana vitrectomy (PPV), retinal foreign body removal and retinal vascular cannulation were performed in two different sizes of an animal model. Endolaser was performed in the eye of a living Irish rabbit and the other tasks were done in a harvested porcine eye. For each evaluation, the duration and the successful completion of the task was assessed. RESULTS Robot-assisted vitreoretinal operations were successfully performed in nine rabbit eyes and 25 porcine eyes without any iatrogenic complication such as retinal tear or retinal detachment. In the task of using an endolaser, three rows of burns around the induced retinal hole were performed in nine rabbit eyes with half size intervals of laser spots. Nine procine eyes underwent PPV followed by successful posterior vitreous detachment (PVD) induction assisted with triamcinolone acetonide (TA). Nine porcine eyes completed removal of a fine stainless steel wire, which was inserted into prepared retinal tissue. Finally, retinal vascular cannulation with a piece of stainless steel wire (6mm length, 45 μm pipe diameter and one end cut to ∼30° slope) was successfully achieved in seven porcine eyes. The average duration of each procedure was 10.91±1.22 min, 11.68±2.11min, 5.90±0.46 min and 13.5±6.2 min, respectively. CONCLUSIONS Maneuverability, accuracy and stability of robot-assisted vitreoretinal microsurgery using the RVRMS were demonstrated in this study. Wider application research of robotic surgery and improvement of a robotic system should be continued.
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Affiliation(s)
- Yi-Qi Chen
- Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.,Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ji-Wei Tao
- Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Ling-Ya Su
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Liang Li
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shi-Xin Zhao
- Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Yang Yang
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Li-Jun Shen
- Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China. .,Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Ferreira C, Brychaert PE, Menard J, Mandron E. Laparoscopic implantation of artificial urinary sphincter in women with intrinsic sphincter deficiency: Mid-term outcomes. Int J Urol 2017; 24:308-313. [PMID: 28215049 DOI: 10.1111/iju.13296] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/26/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To analyze the safety and the mid-term continence rates of laparoscopic implantation of artificial urinary sphincter in women. METHODS A total of 52 women with intrinsic sphincter deficiency underwent a laparoscopic artificial urinary sphincter implantation from 2005 to 2015 at Surgical Clinic Du Pré, Le Mans, France. The artificial urinary sphincter was implanted around the bladder neck by a transperitoneal laparoscopic approach to the Retzius space. Urodynamic assessment was carried out. Postoperative functional outcome was defined as success (no leaking, no pad use), improvement (>50% decrease in number of leakages, >50% decrease in number of pads used or use of light protection) or failure (<50% improvement, persistent or increased leaking). Outcome measures also included perioperative and long-term complications. RESULTS The mean age of the patients was 69.1 years (range 64-82 years). After a mean follow up of 37.5 months (median 24 months; range 1-125 months), 38 (77.6%) patients were considered to be continent (no leakage, no pads), and eight (16.3%) improved their grade of incontinence. Three patients abandoned the follow-up schedule and were excluded. There was no perioperative severe complication. Artificial urinary sphincter revision was needed in 11 (22.4%) patients, requiring a total of seven redo procedures and four permanent sphincter removals. The main reasons for redo procedures were six (11.2%) mechanical problems and one vaginal erosion (2%). CONCLUSIONS Herein we report one of the largest series with the longest follow up evaluating the outcomes of laparoscopic artificial urinary sphincter implantation in female patients. This approach seems to be a safe and effective treatment option for patients with intrinsic sphincter deficiency.
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Affiliation(s)
- Carlos Ferreira
- Department of Urology, Surgical Clinic Du Pré, Technopôle Université, Le Mans, France
| | | | - Johann Menard
- Department of Urology, Surgical Clinic Du Pré, Technopôle Université, Le Mans, France
| | - Eric Mandron
- Department of Urology, Surgical Clinic Du Pré, Technopôle Université, Le Mans, France
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Biardeau X, Aharony S, Campeau L, Corcos J. Artificial Urinary Sphincter: Report of the 2015 Consensus Conference. Neurourol Urodyn 2017; 35 Suppl 2:S8-24. [PMID: 27064055 DOI: 10.1002/nau.22989] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The AMS800™ device, by far the most frequently implanted artificial urinary sphincter (AUS) worldwide, is considered to be the "gold-standard" when male incontinence surgical treatment is contemplated. Despite 40 years of experience, it is still a specialized procedure with a number of challenges. Here, we present the recommendations issued from the AUS Consensus Group, regarding indications, management, and follow-up AMS800™ implantation or revision. MATERIALS AND METHODS Under ICS auspices, an expert panel met on July 10, 2015 in Chicago, IL, USA in an attempt to reach a consensus on diverse issues related to the AMS800™ device. Participants were selected by the two co-chairs on the basis of their practice in a University hospital and their experience: number of implanted AUSs according to AMS (American Medical System Holdings Inc., Minnetonka, MN) records and/or major published articles. Topics listed were the result of a pre-meeting email brainstorming by all participants. The co-chairs distributed topics randomly to all participants, who then had to propose a statement on each topic for approval by the conference after a short evidence-based presentation, when possible. RESULTS A total of 25 urologists were invited to participate, 19 able to attend the conference. The present recommendations, based on the most recent and relevant data available in literature as well as expert opinions, successively address multiple specific and problematic issues associated with the AMS800™ trough a eight-chapter structure: pre-operative assessment, pre operative challenges, implantation technique, post-operative care, trouble-shooting, outcomes, special populations, and the future of AUSs. CONCLUSION These guidelines undoubtedly constitute a reference document, which will help urologists to carefully select patients and apply the most adapted management to implantation, follow-up and trouble-shooting of the AMS800™.
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Affiliation(s)
- X Biardeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - S Aharony
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | | | - L Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - J Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
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Hervé F, Lumen N, Goessaert AS, Everaert K. Persistent urinary incontinence after a robot-assisted artificial urinary sphincter procedure: lessons learnt from two cases. BMJ Case Rep 2016; 2016:bcr-2016-216971. [PMID: 27797881 DOI: 10.1136/bcr-2016-216971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This case report describes 2 cases of persistent urinary incontinence in the beginning of the learning curve of robot-assisted bladder neck implantation of an artificial urinary sphincter (RA-AUS) in men at risk for erosion due to neurological lesions. Among a series of 4 RA-AUS, 2 patients still experienced urinary incontinence after surgery. A complete urological workup was strictly normal and did not show any device malfunction. However, during an AUS revision in these two patients, exploration revealed that the cuff was not tight enough. This issue was resolved by placing smaller cuffs. After re-do surgery, one of the two patients no longer had urinary incontinence, while the second patient was lost to follow-up. Insufficient tightness of the cuff could be explained by an inability of the surgeon to feel the force while pulling the cuff around the urethra due to the absence of haptic sensation in robotic surgery.
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Affiliation(s)
- François Hervé
- Department of Urology, Universitair Ziekenhuis Gent, Gent, Belgium
| | - Nicolaas Lumen
- Department of Urology, Universitair Ziekenhuis Gent, Gent, Belgium
| | | | - Karel Everaert
- Department of Urology, Universitair Ziekenhuis Gent, Gent, Belgium
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Phé V, Léon P, Granger B, Denys P, Bitker MO, Mozer P, Chartier-Kastler E. Stress urinary incontinence in female neurological patients: long-term functional outcomes after artificial urinary sphincter (AMS 800TM
) implantation. Neurourol Urodyn 2016; 36:764-769. [DOI: 10.1002/nau.23019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/30/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Véronique Phé
- Department of Urology; Pitié-Salpêtrière Academic Hospital; Assistance Publique-Hôpitaux de Paris; Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Priscilla Léon
- Department of Urology; Pitié-Salpêtrière Academic Hospital; Assistance Publique-Hôpitaux de Paris; Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Benjamin Granger
- Department of Statistics; Pitié-Salpêtrière Academic Hospital; Assistance Publique-Hôpitaux de Paris; Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré Hospital; Assistance Publique-Hôpitaux de Paris; Paris France
| | - Marc-Olivier Bitker
- Department of Urology; Pitié-Salpêtrière Academic Hospital; Assistance Publique-Hôpitaux de Paris; Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Pierre Mozer
- Department of Urology; Pitié-Salpêtrière Academic Hospital; Assistance Publique-Hôpitaux de Paris; Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Emmanuel Chartier-Kastler
- Department of Urology; Pitié-Salpêtrière Academic Hospital; Assistance Publique-Hôpitaux de Paris; Pierre and Marie Curie Medical School; Paris 6 University; Paris France
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Biardeau X, Aharony S, Campeau L, Corcos J. Overview of the 2015 ICS Consensus Conference. Neurourol Urodyn 2016; 35:437-43. [DOI: 10.1002/nau.22999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/28/2016] [Indexed: 11/06/2022]
Affiliation(s)
- X. Biardeau
- Department of Urology, Jewish General Hospital; McGill University; Montreal Quebec Canada
| | - S. Aharony
- Department of Urology, Jewish General Hospital; McGill University; Montreal Quebec Canada
| | - L. Campeau
- Department of Urology, Jewish General Hospital; McGill University; Montreal Quebec Canada
| | - J. Corcos
- Department of Urology, Jewish General Hospital; McGill University; Montreal Quebec Canada
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Suarez OA, McCammon KA. The Artificial Urinary Sphincter in the Management of Incontinence. Urology 2016; 92:14-9. [PMID: 26845050 DOI: 10.1016/j.urology.2016.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/13/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
Despite the emergence of different devices in the treatment of postprostatectomy urinary incontinence, the AMS 800 (American Medical Systems, Minnetonka, MN) remains the gold standard for the treatment of stress urinary incontinence in men. We reviewed the current literature regarding the indications, surgical principles, outcomes, and complications of artificial urinary sphincter placement for stress urinary incontinence after prostatectomy. Despite all the available information, heterogeneous data, different success definitions, and the lack of high-quality prospective studies with long-term follow-up, it is difficult to compare outcomes between studies. In spite of these, the perineal implantation of a single cuff artificial urinary sphincter has withstood the test of time.
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Re: Xavier Biardeau, Jérôme Rizk, François Marcelli, Vincent Flamand. Robot-assisted Laparoscopic Approach for Artificial Urinary Sphincter Implantation in 11 Women with Urinary Stress Incontinence: Surgical Technique and Initial Experience. Eur Urol 2015;67:937-42. Eur Urol 2015; 69:e45-6. [PMID: 26456681 DOI: 10.1016/j.eururo.2015.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
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Reply to Véronique Phé, Morgan Rouprêt, and Emmanuel Chartier-Kastler's Letter to the Editor re: Xavier Biardeau, Jérôme Rizk, François Marcelli, Vincent Flamand. Robot-assisted Laparoscopic Approach for Artificial Urinary Sphincter Implantation in 11 Women with Urinary Stress Incontinence: Surgical Technique and Initial Experience. Eur Urol 2015;67:937-42. Eur Urol 2015; 69:e47-8. [PMID: 26454705 DOI: 10.1016/j.eururo.2015.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/22/2015] [Indexed: 11/23/2022]
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