Female Urology – Incontinence Laparoscopic Approach for Artificial Urinary Sphincter Implantation in Women with Intrinsic Sphincter Deficiency Incontinence: A Single-Centre Preliminary Experience MorganRoupreˆt 1, *, Vincent Misraı¨ 1 , Christophe Vaessen, Vincent Cardot, Florence Cour, Franc ¸ ois Richard, Emmanuel Chartier-Kastler Department of Urology, Groupe Hospitalo-Universitaire EST, Pitie ´-Salpe ´trie `re Hospital, AssistancePublique-Hoˆpitaux de Paris (AP-HP), Faculte ´ de Me ´decine Pierre et Marie Curie, University Paris VI, Paris, France EUROPEAN UROLOGY 57 (2010) 499–505 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted March 23, 2009 Published online ahead of print on March 31, 2009 Keywords: Urinary incontinence Laparoscopy Urinary sphincter Artificial Biomaterial Abstract Background: Implantation of an artificial urinary sphincter (AUS) is used as a last resort in women with stress urinary incontinence (SUI). Objective: To assess the early functional outcome after laparoscopic placement of an AUS in women. Design, setting, and participants: Twelve women with type 3 SUI underwent a laparo- scopic AUS placement between 2006 and 2008. Eleven (92%) had previously undergone anti-incontinence procedures. Intervention: The AUS was implanted with laparoscopic access either preperitoneally or intraperitoneally. The cuff was placed around the bladder neck between the periurethral fascia and the vagina. Measurements: Perioperative complications were reviewed. To assess resolution of urinary incontinence, all patients were seen at 1, 3, 6, and 12 mo after the surgery and yearly thereafter. Results and limitations: The mean age of subjects was 56.7 Æ 12 yr (33–78). The mean body mass index was 24 Æ 2.3 (20–25). The mean preoperative closure pressure was 22 Æ 10.9 cmH 2 O (4–35). The mean operative time was 181 Æ 39 min [110–240]. Intra- operative complications occurred in three women (25%), with bladder (n = 2) and vaginal (n = 2) injuries. These complications required open conversion. AUS implantation was postponed in one case. The mean hospital stay was 7 Æ 2.3 d (3–11). The bladder catheter was removed after a mean time of 10 Æ 8 d (2–30). Urinary retention was observed in five cases (45%) after bladder catheter removal. AUS activation was done 4–14 wk after implanta- tion. Mean follow-up was 12.1 Æ 8 mo (5.2–27). Incontinence was completely resolved in eight women (88%) who underwent complete laparoscopic procedure. The main limitation of the study was the limited length of follow-up. Conclusions: AUS implantation can be successfully achieved by laparoscopy. It appears to be technically feasible. These results are still preliminary, and further studies of larger populations with longer follow-up are needed to make any statement regarding surgical strategy. # 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved. 1 The first two authors contributed equally to this paper. * Corresponding author. Hospital Pitie ´ -Salpe ´ trie ` re, Academic Urology Department, 47-83 Boulevard de l’Hopital, 75013 Paris, France. E-mail address: morgan.roupret@psl.aphp.fr (M. Roupre ˆt). 0302-2838/$ – see back matter # 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2009.03.045