Artificial urinary sphincters (AUSs) are most-frequently placed in men with urinary incontinence as a result of radical prostatectomy. The placement of these devices in women is much rarer, and is generally only a last resort in patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency. The open surgical procedure for AUS placement can be complicated in these women, particularly in those who have undergone previous pelvic surgery. A team of French researchers have now described their positive 4-year experience with laparoscopic AUS placement in 25 women with SUI and a history of urogynecological surgery.

The patients had a mean age of 66.8 years and a mean BMI of 26.8 kg/m2. The mean operative time was 92 min (range 63–146 min), although this includes the 6 women who required simultaneous promontofixation for urogenital prolapse. Estimated blood loss was <100 ml in all cases, and only one intraoperative complication (vaginal perforation) occurred, which was corrected during surgery.

Urinary retention was present in 5 patients following removal of the urethral catheter 2 days after surgery; this resolved after a further 2 days of catheterization in 4 patients and after 4 weeks of suprapubic catheterization in the fifth patient. Transient postoperative urinary tract infection was identified in four patients.

AUS removal was necessary in two patients who developed vaginal erosion. The remaining 23 patients had either complete continence (n = 19) or 'social' continence (one pad per day; n = 4) at a mean follow-up of 26.1 months.

These results demonstrate the safety and feasibility of laparoscopic AUS placement in women, although randomized studies are needed to compare it with the open technique.