Skip to main content

Advertisement

SpringerLink
Log in

Mid-term results of the Remeex® readjustable sling for female complex stress urinary incontinence and sonographic hypomobile urethra

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

We aimed to evaluate the results of a readjustable sling (Remeex® system) among a selected group of women with complex stress urinary incontinence (SUI) with sonographic hypomobile urethra and assessing failure-related risk factors.

Methods

Observational, longitudinal, prospective cohort study, including patients who underwent surgery with the Remeex® system. The primary outcome was a binary outcome in change of one level or more of the severity of urinary incontinence symptoms according to the intervals of the Incontinence Questionnaire-Short Form (ICIQ-UI-SF) score (mild, moderate, severe and very severe). Secondary outcomes were postsurgical complications, absolute ICIQ-UI-SF, 24-h pad weight test (24-h PT), urodynamic SUI and Patient Global Impression of Improvement (PGI-I) score to evaluate subjective success.

Results

Among 120 women included, after surgery we found a 70% subjective success rate, a 76.7% decrease of urinary incontinence severity and a mean reduction of the 24-h PT of 109.6 ± 291.4 g. Women with post-surgical decreased severity of incontinence had lower mean body mass index (BMI) and 24-h PT than those without incontinence severity changes with statistically significant differences (p = 0.028 and p = 0.027, respectively). A logistic regression model demonstrated that a 1-point increase of BMI increased the risk of persistence of incontinence severity after surgery by 19% (OR = 1.19; 95% CI: 1.01–1.41; p = 0.040), and an increase of 10 g in the pre-surgical 24-h PT represented a 3% rise of the aforementioned risk (OR = 1.03; 95% CI: 1.01–1.06; p = 0.034).

Conclusions

In patients with complex SUI and sonographic hypomobile urethra, use of a readjustable sling (Remeex® system) led to improvement of SUI. Patients with a greater BMI and pre-surgical 24-h PT showed worse results after surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Stav K, Dwyer PL, Rosamilia A, Schierlitz L, Lim YN, Lee J. Risk factors of treatment failure of midurethral sling procedures for women with urinary stress incontinence. Int Urogynecol J. 2010 Feb;21(2):149–55. https://doi.org/10.1007/s00192-009-1020-9.

    Article  PubMed  Google Scholar 

  2. Schierlitz L, Dwyer PL, Rosamilia A, Murray C, Thomas E, De Souza A, Hiscock R. Three-year follow-up of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency. Obstet Gynecol. 2012;119(2 Pt 1):321–7. https://doi.org/10.1097/AOG.0b013e31823dfc73.

    Article  PubMed  Google Scholar 

  3. Lee KS, Choo MS, Doo CK, Han DH, Lee YS, Kim JY, Kim WS, Jung HC. The long term (5-years) objective TVT success rate does not depend on predictive factors at multivariate analysis: a multicentre retrospective study. Eur Urol. 2008;53(1):176–82. https://doi.org/10.1016/j.eururo.2007.08.033.

    Article  PubMed  Google Scholar 

  4. Kim A, Kim MS, Park YJ, Choi WS, Park HK, Paick SH, Kim HG. Retropubic versus transobturator mid urethral slings in patients at high risk for recurrent stress incontinence: a systematic review and meta-analysis. J Urol. 2019;202(1):132–42. https://doi.org/10.1097/JU.0000000000000222.

    Article  PubMed  Google Scholar 

  5. Ford AA, Ogah JA. Retropubic or transobturator mid-urethral slings for intrinsic sphincter deficiency-related stress urinary incontinence in women: a systematic review and meta-analysis. Int Urogynecol J. 2016;27(1):19–28. https://doi.org/10.1007/s00192-015-2797-3.

    Article  PubMed  Google Scholar 

  6. Meschia M, Pifarotti P, Gattei U, Bertozzi R. Tension-free vaginal tape: analysis of risk factors for failures. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(4):419–22. https://doi.org/10.1007/s00192-006-0161-3.

    Article  PubMed  Google Scholar 

  7. Liapis A, Bakas P, Creatsas G. Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape. Eur Urol. 2009;55(6):1450–5. https://doi.org/10.1016/j.eururo.2009.03.025.

    Article  PubMed  Google Scholar 

  8. Agur W, Riad M, Secco S, Litman H, Madhuvrata P, Novara G, Abdel-Fattah M. Surgical treatment of recurrent stress urinary incontinence in women: a systematic review and meta-analysis of randomised controlled trials. Eur Urol. 2013;64(2):323–36. https://doi.org/10.1016/j.eururo.2013.04.034.

    Article  PubMed  Google Scholar 

  9. Parden AM, Gleason JL, Jauk V, Garner R, Ballard A, Richter HE. Incontinence outcomes in women undergoing primary and repeat midurethral sling procedures. Obstet Gynecol. 2013;121(2 Pt 1):273–8. https://doi.org/10.1097/AOG.0b013e31827c5de7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. El-Hamamsy D, Tincello DG. Recurrent stress urinary incontinence surgery in the United Kingdom: an analysis of the British Society of Urogynaecology database (2007-2015). Int Urogynecol J. 2021;32(1):167–72. https://doi.org/10.1007/s00192-020-04420-3.

    Article  PubMed  Google Scholar 

  11. Errando-Smet C, Ruiz CG, Bertrán PA, Mavrich HV. A re-adjustable sling for female recurrent stress incontinence and intrinsic sphincteric deficiency: long-term results in 205 patients using the Remeex sling system. Neurourol Urodyn. 2018;37(4):1349–55. https://doi.org/10.1002/nau.23444.

    Article  PubMed  Google Scholar 

  12. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26. https://doi.org/10.1007/s00192-009-0976-9.

    Article  PubMed  Google Scholar 

  13. Welk B, Al-Hothi H, Winick-Ng J. Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence. JAMA Surg. 2015;150(12):1167–75. https://doi.org/10.1001/jamasurg.2015.2590.

    Article  PubMed  Google Scholar 

  14. Rosier PFWM, Schaefer W, Lose G, Goldman HB, Guralnick M, Eustice S, Dickinson T, Hashim H. International continence society good urodynamic practices and terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure-flow study. Neurourol Urodyn. 2017;36(5):1243–60. https://doi.org/10.1002/nau.23124.

    Article  PubMed  Google Scholar 

  15. Espuña Pons M, Rebollo Álvarez P, Puig CM. Validation of the Spanish version of the international consultation on incontinence questionnaire-short form. A questionnaire for assessing the urinary incontinence. Med Clin. 2004;122:288–92. https://doi.org/10.1016/s0025-7753(04)74212-8.

    Article  Google Scholar 

  16. Klovning A, Avery K, Sandvik H, Hunskaar S. Comparison of two questionnaires for assessing the severity of urinary incontinence: the ICIQ-UI SF versus the incontinence severity index. Neurourol Urodyn. 2009;28(5):411–5. https://doi.org/10.1002/nau.20674.

    Article  PubMed  Google Scholar 

  17. Guralnick ML, Fritel X, Tarcan T, Espuna-Pons M, Rosier PFWM. ICS educational module: cough stress test in the evaluation of female urinary incontinence: introducing the ICS-uniform cough stress test. Neurourol Urodyn. 2018;37(5):1849–55. https://doi.org/10.1002/nau.23519.

    Article  PubMed  Google Scholar 

  18. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Van Kerrebroeck P, Victor A. Wein a; standardisation sub-Committee of the International Continence Society. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49. https://doi.org/10.1016/s0090-4295(02)02243-4.

    Article  PubMed  Google Scholar 

  19. Dietz HP, Wilson PD. Anatomical assessment of the bladder outlet and proximal urethra using ultrasound and videocystourethrography. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(6):365–9. https://doi.org/10.1007/BF02199565.

    Article  CAS  PubMed  Google Scholar 

  20. Wlaźlak E, Viereck V, Kociszewski J, Kuszka A, Rautenberg O, Walser C, Surkont G, Gamper M, Fehr MK. Role of intrinsic sphincter deficiency with and without urethral hypomobility on the outcome of tape insertion. Neurourol Urodyn. 2017;36(7):1910–6. https://doi.org/10.1002/nau.23211.

    Article  CAS  PubMed  Google Scholar 

  21. Kociszewski J, Rautenberg O, Perucchini D, Eberhard J, Geissbühler V, Hilgers R, Viereck V. Tape functionality: sonographic tape characteristics and outcome after TVT incontinence surgery. Neurourol Urodyn. 2008;27(6):485–90. https://doi.org/10.1002/nau.20556.

    Article  PubMed  Google Scholar 

  22. Kociszewski J, Kolben S, Barski D, Viereck V, Barcz E. Complications following tension-free vaginal Tapes: accurate diagnosis and complications management. Biomed Res Int. 2015;2015:538391. https://doi.org/10.1155/2015/538391.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(0):205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Park BH, Kim JC, Kim HW, Kim YH, Choi JB, Lee DH. Midterm efficacy and complications of readjustable midurethral sling (Remeex system) in female stress urinary incontinence with recurrence or intrinsic sphincter deficiency. Urology. 2015;85(1):79–84. https://doi.org/10.1016/j.urology.2014.10.003.

    Article  PubMed  Google Scholar 

  25. Giberti C, Gallo F, Cortese P, Visalli F. Mid- to long-term results of the Remeex system for the treatment of female incontinence due to intrinsic sphincter deficiency: a retrospective analysis of the first 50 patients. Neurourol Urodyn. 2017;36(3):770–3. https://doi.org/10.1002/nau.23020.

    Article  PubMed  Google Scholar 

  26. Plata M, Robledo D, Bravo-Balado A, Castaño JC, Osorio C, Salazar M, Velásquez JG, Trujillo CG, Caicedo JI, Cataño JG. Effectiveness of the Remeex system™ in Colombian women with recurrent stress urinary incontinence or intrinsic sphincter deficiency. Int Urogynecol J. 2018;29(9):1371–8. https://doi.org/10.1007/s00192-018-3568-8.

    Article  PubMed  Google Scholar 

  27. Hegde A, Nogueiras M, Aguilar VC, Davila GW. Dynamic assessment of sling function on transperineal ultrasound: does it correlate with outcomes 1 year following surgery? Int Urogynecol J. 2017;28(6):857–64. https://doi.org/10.1007/s00192-016-3234-y.

    Article  PubMed  Google Scholar 

  28. Sousa-Escandón A, Lema Grillé J, Rodríguez Gómez JI, Rios Tallón L, Uribarri González C, Marqués-Queimadelos A. Externally readjustable device to regulate sling tension in stress urinary incontinence: preliminary results. J Endourol. 2003;17(7):515–21. https://doi.org/10.1089/089277903769013702.

    Article  PubMed  Google Scholar 

  29. Song PH, Hyun CH, Shin E, Jung HC. Effects of the REMEEX system in female patients with intrinsic Sphincteric deficiency and recurrent urinary incontinence: 3-year outcomes. Low Urin Tract Symptoms. 2012;4(3):120–5. https://doi.org/10.1111/j.1757-5672.2012.00146.x.

    Article  PubMed  Google Scholar 

  30. Chung JW, Yoo ES. Efficacy and safety of a readjustable midurethral sling (Remeex system) for stress urinary incontinence with female voiding dysfunction. Investig Clin Urol. 2017;58(2):127–33. https://doi.org/10.4111/icu.2017.58.2.127.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Taithongchai A, Pandeva I, Sultan AH, Thakar R. Association between 3D endovaginal and 2D perineal pelvic floor ultrasound findings and symptoms in women presenting with mid-urethral sling complications. Ultrasound Obstet Gynecol. 2021;57(4):639–46. https://doi.org/10.1002/uog.23130.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Cristina Ros and Sílvia Escura contributed equally to this work.

Authors and Affiliations

  1. Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Cristina Ros, Sílvia Escura, Sònia Anglès-Acedo, Marta Larroya, Eduardo Bataller, Emília Sánchez, Montserrat Espuña-Pons & Francisco Carmona

  2. Pelvic Floor Unit, Hospital Sant Joan de Déu de Barcelona, University of Barcelona, Barcelona, Spain

    Lluís Amat

Authors
  1. Cristina Ros
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sílvia Escura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sònia Anglès-Acedo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marta Larroya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eduardo Bataller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lluís Amat
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emília Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Montserrat Espuña-Pons
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francisco Carmona
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

C. Ros: project development, data collection, data analysis, manuscript writing, manuscript editing.

S. Escura: project development, data collection, data analysis, manuscript writing, manuscript editing.

S. Anglès-Acedo: manuscript editing.

M. Larroya: data collection.

E. Bataller: surgery.

LL. Amat: surgery, data collection.

E. Sánchez: data analysis.

M. Espuña-Pons: project development, manuscript editing.

F. Carmona: manuscript editing.

Corresponding author

Correspondence to Cristina Ros.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ros, C., Escura, S., Anglès-Acedo, S. et al. Mid-term results of the Remeex® readjustable sling for female complex stress urinary incontinence and sonographic hypomobile urethra. Int Urogynecol J 33, 903–910 (2022). https://doi.org/10.1007/s00192-021-04972-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-021-04972-y

Keywords

Search

Navigation