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

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.