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The suburethral tension adjustable sling (REMEEX system) in the treatment of female urinary incontinence due to ‘true’ intrinsic sphincter deficiency: results after 5 years of mean follow‐up
Author(s) -
Giberti Claudio,
Gallo Fabrizio,
Cortese Pierluigi,
Sche Maurizio
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09994.x
Subject(s) - medicine , sling (weapon) , urinary incontinence , cystoscopy , surgery , sphincter , urethra , stress incontinence , artificial urinary sphincter , urology , urinary system , quality of life (healthcare) , nursing
Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The treatment of female stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) still remains a very difficult target for urologists. Tension‐free sling positioning is the most used procedure. However, in cases of ISD with fixed urethra, or following anti‐incontinence and surgical procedures, tension‐free slings are more likely to fail spurring an interest in alternative less invasive but more effective techniques. The aim of our study was to assess the outcomes of Remeex procedure in a worse prognosis patient group affected by “true” ISD (mainly iathrogenic ISD with lead pipe and fixed urethra). Our data provided a longer follow‐up than those reported in literature to date, confirming the effectiveness and durability of the Remeex technique up to five years after surgery. OBJECTIVE • To retrospectively report the objective and subjective outcomes of suburethral tension adjustable sling (Remeex system) implantation for stress urinary incontinence (SUI) caused by ‘true’ intrinsic sphincter deficiency (ISD) with fixed urethra. PATIENTS AND METHODS • Thirty female patients with severe SUI, mainly because of iatrogenic ISD, underwent Remeex system positioning between May 2002 and July 2008 (mean follow‐up 60.6 months, range 22–96 months). • Before surgery, patients were evaluated by physical examination, translabial ultrasonography, flexible cystoscopy, urodynamics, 1‐hour pad test and compilation of a quality‐of‐life questionnaire. • Postoperatively, based on the physical examination and pad test, patients were stratified into three groups: (i) Cured: perfectly dry patients at stress test, pad weight 0–1 g; (ii) Improved: patients with mild to moderate incontinence, pad weight 2–50 g; and (iii) Failed: unchanged or worsened patients, pad weight >50 g. RESULTS • At the final follow‐up visit, 26 (86.0%) patients were cured, 2 (7.0%) were improved and 2 (7.0%) had failed. • In particular, the total mean pad weight decreased to 33.2 ± 15.6 (71%) and the total mean questionnaire score significantly increased to 86.9 ± 6.7 (74.0%). • Sling tension readjustment was needed during follow‐up in two patients (7%). • Among the complications, persistent urinary retention (10%), seroma formation (3%) and de novo urgency (7%) were easily treated. CONCLUSION • The Remeex system produced remarkable 5‐year results with a low complication rate. These outcomes have also been confirmed in a worse prognosis patient group as reported in the present study.