Robot-assisted anterior abdomino-vaginal mesh suspension for stress urinary incontinence associated with anterior compartment pelvic organ prolapse: technique, imaging workflow, and 12-month pilot outcomes.

BACKGROUND: Stress urinary incontinence (SUI) frequently coexists with pelvic organ prolapse (POP). Advanced prolapse may mask SUI, which can also develop de novo after prolapse reduction. Current management is based on standardized clinical evaluation using IUGA/ICS terminology and the POP-Q system, integrated with functional imaging such as transperineal ultrasound and dynamic pelvic floor MRI, including MR defecography when indicated. These tools allow accurate assessment of multicompartment prolapse and urethro-cervical mobility. This study describes a robot-assisted anterior abdomino-vaginal mesh suspension (AAVMS), revisiting a historical abdomino-vaginal mesh concept with modern robotic techniques.

MATERIALS AND METHODS: From January 2024 to January 2025, sixteen women aged 55-65 years with anterior compartment POP and symptomatic SUI underwent robot-assisted AAVMS and were followed for 12 months. The primary endpoint was patient-reported resolution of SUI at 12 months. Secondary endpoints included perioperative outcomes, adverse events, POP-Q changes, and patient-reported quality of life (P-QOL) and sexual function (PISQ-12).

RESULTS: Operative time ranged from 50 to 90 min. Urinary catheter removal occurred on postoperative day 3, and discharge on days 8-10. At 6 months, 8/16 patients reported complete continence; this increased to 12/16 at 8 months and 15/16 at 12 months. One patient had persistent SUI. No intraoperative or postoperative complications or mesh-related adverse events were observed.

CONCLUSIONS: Robot-assisted AAVMS was feasible and associated with progressive improvement in patient-reported continence over 12 months, with a favorable safety profile. Larger comparative studies with standardized objective endpoints are warranted.