A re-adjustable sling for female recurrent stress incontinence and intrinsic sphincteric deficiency: Long-term results in 205 patients using the Remeex sling system

Aims: To evaluate the outcomes and complications at long-term follow-up after a Remeex re-adjustable sling for recurrent stress urinary incontinence (rSUI) and intrinsic sphincteric deficiency (ISD) in women. Methods: Two hundred thirty women with SUI were evaluated after undergoing a re-adjustable sling operation. Twenty-five patients were lost to follow-up, 205 were classified by Q-tip, urodynamic, and clinical criteria into ISD (109) and rSUI (96). Outcome measures included number of pads, 1 h pad-test, urodynamics and subjective satisfaction index with the procedure. Results: After a mean follow-up of 89 months (26-159), 165 patients were cured of SUI (71.7% in the intention to treat analysis (itt), 80.5% in per protocol analysis (pp)). Forty patients remained incontinent (17.4% in itt, 19.5 in pp). Thirty-one patients (15.1%) had detrusor overactivity (DH) incontinence, 21 (10.2%) with de-novo DH and 10 with previous urodynamic mixed incontinence. Eighty-eight patients required re-adjustment of the sling during the follow-up. The tension was increased in 82 cases due to recurrence of SUI and reduced in six due to outlet obstruction. The overall complications rate was 28.8%, (3.4% clavien III). Conclusions: The Remeex re-adjustable sling provides a good cure rate for rSUI and ISD at long-term follow-up. The complications rate is acceptable since most complications are clavien II. The ability to re-adjust the sling tension during the follow-up allowed us to achieve cure for recurrence after the initial procedure, and to relieve obstruction in every case attempted.