Robot- assisted AMS-800-sphincter implantation around the membranous urethra in spina bifida – a new cuff position
Robot-assisted AMS 800™- sphincter implantation around the membranous urethra in spina bifida - a new cuff position
N. Abo Youssef1, M. Randazzo1, J. Pannek2, K. Horton1, H. John1
1Kantonsspital Winterthur, Klinik für Urologie, Winterthur, Schweiz, 2Schweizer Paraplegiker-Zentrum Nottwil, Neuro-Urologie, Nottwil, Schweiz
Introduction Neurogenic lower urinary tract dysfunctions have an important impact on the quality of life in patients due to spina bifida. The artificial urinary sphincter AMS 800™ has been used for years as standardized long-term therapy in patients with severe stress incontinence. A robot-assisted subprostatic cuff positioning around the membranous urethra has not yet been described in the literature.
Methods This video shows the robot-assisted AMS 800™-sphincter implantation in a 43-year-old patient with neurogenic voiding dysfunction as a result of impaired detrusor contractility due to spina bifida. After initiating a transperitoneal approach we performed the extraperitonealisation of the bladder and the incision of the endopelvic fascia in a first step. This was followed by the enlacement and measurement of the membranous urethral circumference. The cuff was positioned at the implant site with mesh towards the outside and “pillow” side towards the urethra. The pressureregulating balloon was implanted through the 12 mm trocar and the connecting-tubing through another suprapubic trocar. After tunnelling through the trocar position and creating a dependent subdartos pouch in the scrotum, the control pump was placed into the scrotal pouch.
Results The blood loss was irrelevant and there were no intra- or postoperative complications. The newly implanted membranous AMS 800™-sphincter has been activated 6 weeks postoperative. 6 months after surgery the patient showed a satisfying continence with a use of 1-2 pads/day (preoperative 5-6 pads/day).
Conclusion The subprostatic, robot-assisted implantation of an AMS 800™ around the membranous urethra is a new minimal-invasive therapeutic option. To our knowledge, this approach has not been described in the literature so far.