First Russian experience of artificial urinary sphincter implantation in a woman using the da Vinci robotic system: technical aspects and long-term treatment outcomes

Vollständiger Abstract

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Introduction. Artificial urinary sphincter (AUS) implantation in women remains a challenging procedure due to the technical difficulties of open surgery, particularly in the setting of scar tissue following prior interventions. Robotic technology may improve outcomes through precise dissection in the narrow pelvic space. Objective. To demonstrate the technical feasibility and efficacy of robot-assisted AUS implantation in a patient with total stress urinary incontinence and a history of multiple unsuccessful surgeries. Materials & methods. We present a clinical case of a 62-year-old patient after hysterectomy, two failed TVT procedures, and synthetic sling incision. Robot-assisted implantation of a three-component sphincter was performed using the da Vinci Si system. Dissection was carried out under conditions of severe scarring with simultaneous visual and transvaginal control. Results. No intraoperative complications were observed. Blood loss was less than 50 ml, and operative time was 160 minutes. The postoperative course was uneventful, with no pain requiring narcotic analgesics. At 3-year follow-up, the patient uses 1 pad per day (baseline 5 – 8 pads) and is completely dry at night. Maximum flow rate (Qmax) was 30.1 ml/s, and post-void residual volume was 30 – 40 ml. Conclusion. Robot-assisted AUS implantation is a technically feasible and safe procedure in patients with scar tissue after prior surgeries, providing low invasiveness, precise dissection, and sustained improvement in quality of life.