ロボット支援下仙骨腟固定術および人工尿道括約筋植込み術の同時施行：単回セッション手術アプローチ
David Carracedo Calvo1, Miguel Toledo Jiménez2, Tamara Jerez Izquierdo2
1Servicio de Urología. Hospital Universitario Rey Juan Carlos; Móstoles, Madrid, España; Instituto de Investigación Sanitaria Fundación Jiménez Díaz(IIS-FJD,UAM), Madrid, España.
Objective:
Severe female stress urinary incontinence (SUI), particularly in the context of intrinsic sphincter deficiency, remains a challenging condition, for which the artificial urinary sphincter (AUS) is considered the most effective therapeutic option (1) as well as sacrocolpopexy represents the gold standard for durable anatomical correction and functional improvement in patients with pelvic organ prolapse (POP) (2). Robotic surgery has expanded the possibilities of complex pelvic reconstruction by improving visualization, precision, and ergonomics (3). The objective of this video is to demonstrate the feasibility and effectiveness of a simultaneous robotic approach combining AUS implantation and sacrocolpopexy in a single operative session.
Setting:
Single-hospital experience in a robotic urology and pelvic reconstructive surgery unit.
Participants:
A 62-year-old woman with severe stress urinary incontinence secondary to intrinsic sphincter deficiency confirmed by videourodynamic study and symptomatic apical pelvic organ prolapse.
Intervention:
The video presents a step-by-step robotic technique in which AUS implantation and sacrocolpopexy are performed sequentially during the same surgical procedure. Particular emphasis is placed on the intercalation of key surgical steps to optimize exposure, minimize operative time, and safely address both conditions within a single session.
Conclusion:
In carefully selected patients, the combination of robotic sacrocolpopexy and AUS implantation offers a comprehensive solution for the simultaneous management of apical POP and severe SUI. At 12-month follow-up, this approach resulted in complete continence and durable anatomical correction, with low morbidity and satisfactory functional outcomes. Given the established efficacy of AUS for severe female SUI (1), the durability of sacrocolpopexy for apical prolapse (2), and the technical advantages of robotic surgery in complex pelvic reconstruction (3), this single-session strategy appears to be a safe and efficient option, despite its limited representation in the current literature (4).
