Robotic-assisted artificial urinary sphincter implant complicated by ureteric obstruction

Robotic-assisted surgery is gaining popularity for the implantation of artificial urinary sphincters (AUS) in female patients. We present a case of a 76-year-old woman with refractory stress urinary incontinence. She underwent an uncomplicated robotic-assisted AUS implant. Post activation of the system, she experienced right-sided flank pain and developed urosepsis shortly thereafter. On imaging with an activated system, grade 3 hydro-ureteronephrosis (HUN) was seen. Robotic-assisted revision showed a right-sided ectopic ureter draining towards the bladder neck, which was compressed on activation of the system. A new cuff was successfully placed distal to the orifice with complete continence 3 months after the procedure.