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Araújo D, Bryckaert PE, Miranda M, Rodrigues V, De Saint Aubert N, Menard J, Mandron E. Eighteen years of experience in laparoscopic implantation of artificial urinary sphincter in women with intrinsic sphincter deficiency. Arch Ital Urol Androl 2024; 96:12214. [PMID: 38572722 DOI: 10.4081/aiua.2024.12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Artificial urinary sphincter (AUS) is a treatment option for women with stress urinary incontinence (SUI) after failure of previous surgery or as a primary procedure in severe intrinsic sphincter deficiency (ISD). The aim of the study was to assess the long-term efficacy and risk factors for surgical revision and definitive explantation of AUS laparoscopic implantation in female patients. METHODS A retrospective review of all women submitted to AUS implantation between April 2005 and March 2023 was conducted. The AUS was implanted via transperitoneal laparoscopic approach, by two experienced surgeons. The primary endpoint was postoperative continence. Continence was defined as no leakage and no pad usage or leakage and/or pad usage with no impact on social life and failure as leakage and/or pad usage impacting social life. As secondary outcomes, clinical predictive factors for AUS revision and definitive explantation were evaluated. RESULTS In the last 18 years, females with a mean age of 68±12 years-old were submitted to laparoscopic implantation of AUS. Early overall complication rate was 16%, but only one case was Clavien-Dindo ≥3. After a median follow-up of 67 months, 22.2% of the patients needed a device revision, the majority due to mechanical device dysfunction. AUS definitive explantation was performed in 16%, mainly due to urethral/vaginal erosion (9.9%) and infection (6.2%). Patients with age ≥70 years and follow-up ≥10 years significantly predisposed for device revision. At the time of the last follow-up, 72% of the patients were keeping the urinary continency. CONCLUSIONS Laparoscopic AUS implantation in females is an effective treatment for SUI due to ISD. Meanwhile, adequate patient selection, multidisciplinary evaluation and careful expectation management are essential to achieving good results, concerning their significant complication rate.
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Affiliation(s)
- Débora Araújo
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia.
| | | | - Miguel Miranda
- Urology Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa.
| | - Vasco Rodrigues
- Urology Department, Centro Hospitalar Universitário de São João EPE, Porto.
| | | | - Johann Menard
- Urology Department, Clinique du Pré, Technopôle Université, Le Mans.
| | - Eric Mandron
- Urology Department, Clinique du Pré, Technopôle Université, Le Mans.
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Peyronnet B, Chartier-Kastler E. Artificial urinary sphincter is the best treatment for persistent or reccurent stress urinary incontinence after midurethral sling in female patients: Pro. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102594. [PMID: 38382242 DOI: 10.1016/j.fjurol.2024.102594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Benoit Peyronnet
- Department of Urology, Hospital Pontchaillou, University of Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - Emmanuel Chartier-Kastler
- Department of Urology, Academic Hospital Pitié-Salpêtrière, Sorbonne université, AP-HP, Paris, France
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Vrijens D, Kendall H, Hervé F. Neurological sphincter deficiency: is there a place for artificial urinary sphincter? World J Urol 2024; 42:69. [PMID: 38308692 PMCID: PMC10838219 DOI: 10.1007/s00345-023-04716-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/26/2023] [Indexed: 02/05/2024] Open
Abstract
PURPOSE Neurogenic stress urinary incontinence (N-SUI) is a condition with serious impact on the quality of life. There are several treatment modalities of which the artificial urinary sphincter (AUS) stands out as the most suitable technique for addressing sphincter insufficiency. In this article, the purpose is to describe practical considerations, outcomes, and complications of the artificial urinary sphincter in neurological sphincter deficiency in both males and females. METHODS A narrative review of the current literature. RESULTS The outcomes of AUS are reasonably good in patients with NLUTD, the surgical technique is discussed as well as the limitations and special considerations in this complex and heterogeneous patient population. CONCLUSION The available evidence suggests that its efficacy and functional durability may be lower in patients with neurogenic lower urinary tract dysfunction (NLUTD) compared to those without neurological deficits. However, studies have shown that AUS can still provide effective and safe continence outcomes in both male and female patients, with long-term device survival rates ranging from several years to over a decade.
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Affiliation(s)
- Desiree Vrijens
- Departement of Urology, Maastricht University Medical Centre, Maastricht, Netherlands.
| | - Harry Kendall
- Departement of Urology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - François Hervé
- Departement of Urology, University Hospital of Ghent, Ghent, Belgium
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Geretto P, DE Cillis S, Karsenty G, Candela L, Phé V. Totally intracorporeal robot-assisted supratrigonal cystectomy and ileal augmentation cystoplasty with periprostatic artificial urinary sphincter implantation for male neurogenic mixed urinary incontinence. Minerva Urol Nephrol 2023; 75:272-274. [PMID: 37221825 DOI: 10.23736/s2724-6051.23.05314-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Paolo Geretto
- Department of Urology, Tenon Academic Hospital, Assistance-Publique - Hôpitaux de Paris, Sorbonne University, Paris, France -
- Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy -
| | - Sabrina DE Cillis
- Department of Urology, Tenon Academic Hospital, Assistance-Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gilles Karsenty
- Department of Urology and Kidney Transplantation, La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Luigi Candela
- Department of Urology, Tenon Academic Hospital, Assistance-Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Véronique Phé
- Department of Urology, Tenon Academic Hospital, Assistance-Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
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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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Toniolo I, Mascolini MV, Carniel EL, Fontanella CG. Artificial sphincters: An overview from existing devices to novel technologies. Artif Organs 2023; 47:617-639. [PMID: 36374175 DOI: 10.1111/aor.14434] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/21/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
Artificial sphincters (ASs) are used to replace the function of the biological sphincters in case of severe urinary and fecal incontinence (UI and FI), and gastroesophageal reflux disease (GERD). The design of ASs is established on different mechanisms, e.g., magnetic forces or hydraulic pressure, with the final goal to achieve a implantable and durable AS. In clinical practice, the implantation of in-commerce AS is considered a reasonable solution, despite the sub-optimal clinical outcomes. The failure of these surgeries is due to the malfunction of the devices (between 46 and 51%) or the side effects on the biological tissues (more than 38%), such as infection and atrophy. Concentrating on this latter characteristic, particular attention has been given to the interaction between the biological tissues and AS, pointing out the closing mechanism around the duct and the effect on the tissues. To analyze this aspect, an overview of existing commercial/ready-on-market ASs for GERD, UI, and FI, together with the clinical outcomes available from the in-commerce AS, is given. Moreover, this invited review discusses ongoing developments and future research pathways for creating novel ASs. The application of engineering principles and design concepts to medicine enhances the quality of healthcare and improves patient outcomes. In this context, computational methods represent an innovative solution in the design of ASs, proving data on the occlusive force and pressure necessary to guarantee occlusion and avoid tissue damage, considering the coupling between different device sizes and individual variability.
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Affiliation(s)
- Ilaria Toniolo
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Maria Vittoria Mascolini
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Chiara Giulia Fontanella
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
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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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Yang Y, Wang J, Wang L, Wu Q, Ling L, Yang Y, Ning S, Xie Y, Cao Q, Li L, Liu J, Ling Q, Zang J. Magnetic soft robotic bladder for assisted urination. SCIENCE ADVANCES 2022; 8:eabq1456. [PMID: 36001667 PMCID: PMC9401625 DOI: 10.1126/sciadv.abq1456] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
The poor contractility of the detrusor muscle in underactive bladders (UABs) fails to increase the pressure inside the UAB, leading to strenuous and incomplete urination. However, existing therapeutic strategies by modulating/repairing detrusor muscles, e.g., neurostimulation and regenerative medicine, still have low efficacy and/or adverse effects. Here, we present an implantable magnetic soft robotic bladder (MRB) that can directly apply mechanical compression to the UAB to assist urination. Composed of a biocompatible elastomer composite with optimized magnetic domains, the MRB enables on-demand contraction of the UAB when actuated by magnetic fields. A representative MRB for a UAB in a porcine model is demonstrated, and MRB-assisted urination is validated by in situ computed tomography imaging after 14-day implantation. The urodynamic tests show a series of successful urination with a high pressure increase and fast urine flow. Our work paves the way for developing MRB to assist urination for humans with UABs.
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Affiliation(s)
- Youzhou Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Jiaxin Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Liu Wang
- CAS Key Laboratory of Mechanical Behavior and Design of Materials, Department of Modern Mechanics, University of Science and Technology of China, Hefei 230026, PR China
| | - Qingyang Wu
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Le Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Yueying Yang
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Shan Ning
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Yan Xie
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan 430074, PR China
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Quanliang Cao
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan 430074, PR China
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Liang Li
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan 430074, PR China
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Jianfeng Zang
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
- The State Key Laboratory of Digital Manufacturing Equipment and Technology, Huazhong University of Science and Technology, Wuhan 430074, PR China
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11
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Application of estrogen for the treatment of stress urinary incontinence in mice. Arch Gynecol Obstet 2022; 305:1115-1125. [PMID: 35174407 DOI: 10.1007/s00404-022-06435-1] [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: 01/19/2022] [Accepted: 02/02/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a pervasive health tissue among women, which seriously affects the quality of life. The etiology of SUI is complex and diverse in women, with past studies having demonstrated that estrogen deficiency plays an important role in pelvic floor muscle atrophy and urethral degeneration. We comprehensively investigated the effects of estrogen in the treatment of SUI in female mice at cellular and animal levels. METHODS L929 fibroblasts mechanical injury model was established by four-point bending device, and SUI mouse model was established by vaginal dilation method commonly used to simulate labor injury. After estrogen treatment, the expressions of Collagen I, Collagen III, Elastin, TIMP-1, TIMP-2, MMP-2, and MMP-9 were detected, the leak point pressure (LPP) and abdominal leak point pressure (ALPP) of mice in each group were detected, and both the effect of estrogen on extracellular matrix remodeling of mouse urethra and anterior vaginal wall was observed from the histological level. RESULTS The results revealed that an appropriate amount of estrogen can promote the expression of Collagen I, Collagen III, Elastin, TIMP-1, and TIMP-2, decrease the expression of MMP-2 and MMP-9, and maintain the dynamic balance of MMPs/TIMPs at both cellular and animal levels. Meanwhile, we determined that estrogen can increase the LPP and ALPP values of SUI mice. The collagen fibers' content in the mice treated with estrogen was significantly greater than in the control group mice. CONCLUSIONS The estrogen may alleviate the symptoms of SUI by reconstituting ECM, thus laying a solid foundation for further exploration of estrogen therapy.
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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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Real-life outcomes after artificial urinary sphincter explantation in women suffering from severe stress incontinence. World J Urol 2021; 39:3891-3896. [PMID: 33835209 DOI: 10.1007/s00345-021-03672-y] [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: 11/23/2020] [Accepted: 03/13/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Artificial urinary sphincter (AUS) implantation in female patients results in high satisfaction rates and high functional outcomes, but implantation can be challenging and explantation of the device is fairly common. The objective of this study was to review outcomes after AUS explantation in women. METHODS This is a retrospective, monocentric study of all women who underwent open or laparoscopic AUS implantation between November 1994 and July 2019, and patients with AUS explantation were included. Management after AUS explantation using descriptive analysis was assessed. RESULTS Over a span of 26 years, 111 women had an AUS implanted by a single surgeon. Of these surgeries, 35 explantations in 29 patients were later required: 20 initial AUSs, nine revised AUSs and six reimplanted AUS (rAUSs). The median time to explantation was 15.5 month (± 0.55). After explantation, 13 rAUSs in 10 patients were successful and two attempts failed. The median time between explantation and rAUS was 8 months (± 0.95). At the last follow-up, five patients still had their rAUS and six rAUSs had required explantation after a median time of 6.5 months (± 0.65). Surgery was still possible for 12 patients who did not have a rAUS: three cystectomies, one bladder neck closure with continent urinary diversion, and six mid-urethral slings or adjustable continence therapy balloon implantations. Among the 23 patients who did not need a cystectomy or a bladder neck closure with continent urinary diversion, four were completely dry (17.4%), 11 were improved (47.8%), and eight (34.8%) experienced unchanged incontinence with the post-explantation management. Limitations include retrospective design, heterogeneous management over time and a relatively small population of patients in our cohort. CONCLUSION Reimplantation of an AUS after an explantation seems feasible after at least 6 months. However, the surgery will be more difficult and satisfaction is not guaranteed. Multicenter databases should be created to help surgeons and patients decide on appropriate management strategies after explantation of an AUS.
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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: 0] [Impact Index Per Article: 0] [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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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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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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The Changing Face of Artificial Urinary Sphincter Use in France: The Future is Female. Eur Urol Focus 2020; 6:1248-1250. [DOI: 10.1016/j.euf.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/14/2018] [Indexed: 11/20/2022]
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19
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Kivi M, Ahlberg A, Okas R, Stuehmeier J, Pedrini M, Rehder P. Female urethral avulsion and bladder neck closure: What now? Trigonal tubularization with placement of an artificial urinary sphincter. Urol Case Rep 2020; 33:101279. [PMID: 32489902 PMCID: PMC7260669 DOI: 10.1016/j.eucr.2020.101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/24/2020] [Indexed: 11/04/2022] Open
Abstract
Bladder neck closure after severe polytrauma with an absent urethra poses a huge challenge for a young woman wanting to urinate normally. Considerations are reconstruction of a neourethra and operative means to gain continence. We describe a case of trigonal tubularization to function as a neourethra, together with the implantation of an artificial urinary sphincter. Eleven years after suffering from an open book pelvic rim fracture at 18 years, successful reconstruction of a trigonal neourethra enabled continence and residual-free spontaneous voiding at 29 years.
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Use of bioactive extracellular matrix fragments as a urethral bulking agent to treat stress urinary incontinence. Acta Biomater 2020; 117:156-166. [PMID: 33035698 DOI: 10.1016/j.actbio.2020.09.049] [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: 05/28/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 12/25/2022]
Abstract
Injection of urethral bulking agents is a low-risk, minimally invasive surgical procedure to treat stress urinary incontinence (SUI). In this study, we developed a promising injectable bulking agent comprising extracellular matrix fragments of adipose-derived stem cell sheets (ADSC ECM) and investigated its effectiveness in urethral bulking therapy. The structural integrity and proteins of ADSC sheet ECM were well retained in decellularized ADSC ECM fragments. To locate transplanted ADSC ECM fragments, they were labeled with ultrasmall super-paramagnetic iron oxide nanoparticles, which enabled in vivo monitoring after implantation in a SUI rat model for up to 4 weeks. When ADSC ECM fragments were injected into the rat urethra, they became fully integrated with the surrounding tissue within 1 week. Four weeks after transplantation, host cells had regenerated within the ADSC ECM fragment injection area. Moreover, new smooth muscle tissue had formed around the ADSC ECM fragments, as confirmed by positive staining of myosin. These results indicate that injection of ECM fragments may be a promising minimally invasive approach for treating SUI.
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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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Abstract
PURPOSE OF REVIEW After the Food and Drug Administration Public Health Notification in 2011 regarding transvaginal mesh, there has been a decline in the use of mid-urethral slings (MUS). However, they are an effective treatment option for stress urinary incontinence (SUI) with minimal complications. The management of recurrent SUI after sling continues to be debated. RECENT FINDINGS Long-term follow-up after primary MUS confirms its efficacy and safety. There remains no level 1 evidence for the best next step after a failed MUS. Preferred treatment strategies include placing a repeat MUS with more recent evidence demonstrating no difference in cure rates between transobturator tape and retropubic approach. Pubovaginal slings (PVS) and urethral bulking agents are also acceptable treatment options. A newer bulking agent, polyacrylamide hydrogel, demonstrated excellent short-term success rates in patients after a failed sling. SUMMARY MUS is an effective treatment option for SUI. Patients who develop recurrent urinary incontinence are a heterogeneous population who must be evaluated for detrusor overactivity, misplaced sling, unrecognized ISD. Patients with ISD are more likely to benefit by a PVS. Other patients with demonstrated recurrent SUI will likely do well with a repeat MUS.
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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: 15] [Impact Index Per Article: 3.8] [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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Cornu JN. Hyperplasie bénigne de la prostate et incontinence urinaire. Prog Urol 2020; 30:3S10-3S20. [DOI: 10.1016/s1166-7087(20)30194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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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