Challenges for Developing a Soft Robotics Solution for the Surgical Treatment of Stress Urinary Incontinence in Women.

Advances in soft robotics, smart materials and bio-interfacing may enable the development of implantable artificial muscles (IAMs) to replace or augment biological muscles. emPOWER, a UK Research Council engineering project, is initiating foundational technologies and proof of concept for IAMs. This expert opinion piece considers IAMs in the clinical context of stress urinary incontinence. Conceptually, autologous sling tensioning by an IAM can adjustably restore urethral closure to resist fluctuations in intra-abdominal pressure. This could facilitate sling tension adjustment postoperatively, and patient control when the user anticipates greater physical need. Tailoring an IAM procedure to the individual patient's needs requires considering how to deliver the best pelvic floor configuration when upright and the extent of urethral compression necessary. emPOWER addresses both the development of IAM technologies and the needs of the patient, and has developed proof-of-principle working models for prototype contractile mechanisms (actuators). IAM innovation must meet Idea, Development, Exploration, Assessment, Long-term study for Devices (IDEAL-D) requirements and minimise the risk of complications, notably those associated with transvaginal mesh surgery. Accordingly, an IAM for treating stress urinary incontinence needs to minimise the amount of artificial material used, and contact of such material with the urethra. Placement of the implant should use minimally invasive techniques, and reduce the risk of implant infection.