Abstract
Introduction and hypothesis: We report our experience with the Remeex system™ in women with recurrent stress urinary incontinence (SUI) or intrinsic sphincter deficiency (ISD).
Methods: A multicenter retrospective study was conducted in women who underwent an adjustable sling procedure between 2011 and 2016. We used urodynamic studies (UDS) preoperatively and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and cough stress test (CST) pre- and postoperatively. Primary outcomes were subjective (no leakage reported by the patient) and objective (no leakage during CST) cure and improvement rates (reduction of ≥4 points in ICIQ-SF). Descriptive and inferential statistics were employed.
Results: A total of 50 patients were included. Mean age was 62 years (SD ± 11.35). Median follow-up was 19.5 months [interquartile range (IQR) 12.95-41.38]. Urinary incontinence (UI) was described as moderate and severe by 8 (16%) and 42 (84%) patients, respectively, and 25 (50%) had stress-predominant mixed urinary incontinence (MUI). Objective and subjective cure rates were 90% and 48%, respectively, while 82% of patients achieved improvement. Impact of UI on quality of life (QoL) improved from 10 (IQR 9-10) to 2 (IQR 0-5) (p < 0.0001). Clavien-Dindo II complications occurred in 14 (28%) patients, and one (2%) had IIIa. Tape erosion occurred in one (2%) patient, and five (10%) required readjustments. Logistic regression identified MUI [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.02-10.89] and vaginal atrophy (OR 4.2, 95% CI 1.06-16.03) as predictors of low subjective cure rate. Conclusions: Adjustable slings represent a valuable and safe option in the management of recurrent SUI or ISD, with improvement in QoL. Results should be carefully interpreted due to our small sample and retrospective design. Keywords: Adjustable sling; Intrinsic sphincter deficiency; Remeex system; Stress urinary incontinence. Similar articles Midterm efficacy and complications of readjustable midurethral sling (Remeex system) in female stress urinary incontinence with recurrence or intrinsic sphincter deficiency. Park BH, Kim JC, Kim HW, Kim YH, Choi JB, Lee DH. Urology. 2015 Jan;85(1):79-84. doi: 10.1016/j.urology.2014.10.003. PMID: 25530367 Comparison of the efficacy of tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust™) in the treatment of female stress urinary incontinence: a 1-year follow-up randomized trial. Masata J, Svabik K, Zvara K, Hubka P, Toman A, Martan A. Int Urogynecol J. 2016 Oct;27(10):1497-505. doi: 10.1007/s00192-016-3012-x. Epub 2016 Apr 1. PMID: 27037563 Clinical Trial. A re-adjustable sling for female recurrent stress incontinence and intrinsic sphincteric deficiency: Long-term results in 205 patients using the Remeex sling system. Errando-Smet C, Ruiz CG, Bertrán PA, Mavrich HV. Neurourol Urodyn. 2018 Apr;37(4):1349-1355. doi: 10.1002/nau.23444. Epub 2017 Nov 11. PMID: 29130569 Mid-urethral sling operations for stress urinary incontinence in women. Ford AA, Rogerson L, Cody JD, Ogah J. Cochrane Database Syst Rev. 2015 Jul 1;(7):CD006375. doi: 10.1002/14651858.CD006375.pub3. PMID: 26130017 Updated. Review. Retropubic or transobturator mid-urethral slings for intrinsic sphincter deficiency-related stress urinary incontinence in women: a systematic review and meta-analysis. Ford AA, Ogah JA. Int Urogynecol J. 2016 Jan;27(1):19-28. doi: 10.1007/s00192-015-2797-3. Epub 2015 Jul 29. PMID: 26220506 Review. See all similar articles Cited by Mid-term results of the Remeex® readjustable sling for female complex stress urinary incontinence and sonographic hypomobile urethra. Ros C, Escura S, Anglès-Acedo S, Larroya M, Bataller E, Amat L, Sánchez E, Espuña-Pons M, Carmona F. Int Urogynecol J. 2022 Apr;33(4):903-910. doi: 10.1007/s00192-021-04972-y. Epub 2021 Sep 10. PMID: 34505924
