Robotic ileocystoplasty and bladder neck artificial urinary sphincter insertion: Video demonstration of technique

Abstract

Objective: To present our technique of combined robotic assisted clam ileocystoplasty and artificial bladder neck urinary sphincter (AUS) insertion to treat neurogenic urinary incontinence. Materials and methods: We present the case of a 38 year old male with spina bifida and double incontinence. Pre-operatively this patient was managing by using pads for leakage. He was using 5 pads per day on average and suffered from 3 urinary tract infections (UTI) in 1 year.A robotic clam ileocystoplasty is performed with the patient in a 30 ° Trendelenburg position. The vasa and seminal vesicles (SVs) are dissected revealing the posterior surface of the bladder neck. The space of Retzius is entered, exposing the anterior surface of both the bladder and prostate. A Maryland is then passed through the angle at the base of the SV from posterior to anterior to size the bladder neck circumference. A section of small bowel is isolated and the remaining bowel restored using a covidien stapling device. A transverse incision is made into the bladder and the de-tubularised section of bowel sutured into position. The cuff is then placed through the 5 mm port and positioned around the bladder neck. Following this, the reservoir is placed into the pelvis beside the bladder and inflated with an iodine based solution. Next, the tubing is trimmed, capped and secured under the skin. The patient underwent a procedure to insert the pump in the scrotum and connect all of the tubing 3 weeks later to ensure no infection. This, however, is something to review for future procedures. Sphincter activation occurred 6 weeks following pump insertion. Results: Total hospital stay was 6 days. The catheter was removed at 3 weeks following a cystogram. Urodynamic studies 10 months following the procedure showed a functioning AUS, with normal bladder compliance but persistent neurogenic detrusor over activity, which improved with tolterodine. AUS in this patient negated the need for intermittent self-catheterisation. He did not report any UTI upon follow up. Patient's pad usage decreased from 5 daily preoperatively to 2 daily post operatively, increasing his quality of life. Conclusion: Herein we present a successful outcome of concomitant robotic ileocystoplasty and AUS insertion to treat a patient with severe urinary incontinence due to neurogenic detrusor over activity, small bladder capacity and neurogenic sphincter weakness.