The artificial urinary sphincter represents an effective therapeutic option for stress urinary incontinence resulting from intrinsic sphincter deficiency among women. Nevertheless, adoption of this device remains restricted due to technical challenges and potential risks associated with traditional open surgical implantation. Early investigations using robotic methods have yielded encouraging results; however, only one limited-scale study has directly compared robotic and open techniques. The current investigation seeks to evaluate the outcomes of robotic versus open artificial urinary sphincter placement in women with stress urinary incontinence secondary to intrinsic sphincter deficiency, using a broad, multicenter patient population. Information was retrospectively collected on female patients who underwent either open or robot-assisted implantation of an artificial urinary sphincter between 2006 and 2020 at 12 urology centers. The main endpoint was the frequency of complications within 30 days postoperatively, classified according to the Clavien-Dindo system. Perioperative variables and functional results were contrasted between the robotic and open cohorts. Overall, 135 patients were analyzed, comprising 71 in the robotic cohort and 64 in the open cohort. The open surgery group had higher intraoperative (27.4% vs. 12.7%; P = 0.03) and postoperative (46.8% vs. 15.5%; P < 0.0001) complication rates. A greater proportion of patients in the robotic group attained complete continence (83.3% vs. 62.3%; P = 0.01). Furthermore, the open group demonstrated significantly higher device explantation rates (27.4% vs. 1.4%; P < 0.0001) and revision rates (17.5% vs. 5.6%; P = 0.02). The projected 1-year explantation-free survival was superior in the robotic group (98.6% vs. 78.3%; P = 0.001). Robot-assisted implantation appears to decrease perioperative complications and enhance functional success relative to conventional open implantation in women suffering from stress urinary incontinence.
