Implantation of an artificial urinary sphincter is the surgical treatment of last resort for stress urinary incontinence (SUI) due to sphincter inccompetence. 
It is offering very good functional results but if the cuff is too tight, the patient might not resume spontaneous voiding.

We present the case of Mrs S, 70 years old. She has an history of severe stress urinary incontinence secondary to a pelvic trauma. 
She had her first artificial urinary sphincter AMS 800 in 2012 with good initial result and the disappearance of her SUI. 
After the recurrence of SUI, she had an AUS revision in 202 using the laparoscopic approach. The cuff was witch from 7 cm to 6 cm. After the intervention, she was enable to resume spontaneous voiding and she had to do clean intermittent catheterization. 

We proposed her a new revision of the AUS material.

The patient is placed in the Tredelenburg position with her legs spread. 
The ports are positioned and the different arm of the Hugo Medtronic robot are placed. 

The Retzius space is openend and the farmer tubing is marked and followed until reaching the farmer cuff. The AUS cuff is removed and the cuff measuring device is placed. 
We noticed that the neck dissection had probably left out part of the neck, so we decided to make a new dissection.
As usual, the assistant places a finger in the vagina so that we can locate the plane between the vagina and the bladder neck. The bladder neck is separated from the vagina under constant visual control.

The size of the entire bladder neck is finally measured at 8 cm. A new cuff is inserted and the various parts of the equipment are connected.


The operative time was 130 minutes, with minimal blood loss. There was no post operative complications. After the removal of the bladder catheter, the patient was able to resume spontaneous voiding without post void residual.

An AUS implantation can be done with the HUGO Medtronic robot. When the female patient has difficulty in resuming spontaneous voiding, the AUS cuff may be too tight, and a new revision of the material may be useful with very satisfactory functional results.