V11-07 ROBOT-ASSISTED AMS 800®- SPHINCTER IMPLANTATION AROUND THE MEMBRANOUS URETHRA IN SPINA BIFIDA – A NEW CUFF POSITION

Abstract

You have accessJournal of UrologyED, Infertility & Male Incontinence1 Apr 2018V11-07 ROBOT-ASSISTED AMS 800®- SPHINCTER IMPLANTATION AROUND THE MEMBRANOUS URETHRA IN SPINA BIFIDA – A NEW CUFF POSITION Nadim Abo Youssef, Jürgen Pannek, Kevin Horton, Marco Randazzo, and Hubert John Nadim Abo YoussefNadim Abo Youssef More articles by this author , Jürgen PannekJürgen Pannek More articles by this author , Kevin HortonKevin Horton More articles by this author , Marco RandazzoMarco Randazzo More articles by this author , and Hubert JohnHubert John More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2855AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 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. In this context he underwent previous surgical interventions, namely a bulbar AMS 800®-sphincter implantation in April 2002 and a bulbar double-cuff implantation in January 2003. About 14 years later the patient now complains about progressive stress incontinence. 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 pressure-regulating 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. The balloon was filled with 22 ml dilute Iopamiro 300 / Aqua Dest. (57 ml/60 ml) solution and the procedure was completed with the «Quick Connection» of the tubing. RESULTS The blood loss was irrelevant and there were no intra- or postoperative complications. The newly implanted membranous AMS 800®-sphincter has been activated at about 6 weeks postoperative. 6 months after surgery the patient showed a satisfying continence with a use of 1-2 pads per day (preoperative 5-6 pads/day). CONCLUSIONS 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 is described so far for the first time in the literature. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1163-e1164 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nadim Abo Youssef More articles by this author Jürgen Pannek More articles by this author Kevin Horton More articles by this author Marco Randazzo More articles by this author Hubert John More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...