Department of Surgery, Division of Urology, San Paolo Hospital, Savona, Italy.
Study Type - Therapy (case series) Level of Evidence 4.
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.
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.
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.
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.
Written by:
Giberti C, Gallo F, Cortese P, Schenone M. Are you the author?
Reference: BJU Int. 2011 Jan 11. Epub ahead of print.
doi: 10.1111/j.1464-410X.2010.09994.x
PubMed Abstract
PMID: 21554527
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