ReMeEx device (External Mechanical Regulator) for female stress urinary incontinence: a critical review of a single-operator, long-term experience on implants and readjustments.

OBJECTIVE: A single-operator, long-term (15 years) experience on a sling technique that allows a postoperative adjustment of its tension is presented to retrospectively report the objective and subjective outcomes in the treatment of female stress urinary incontinence (SUI). The readjustment option prevents the need of a reoperation in case of relapse with great compliance of the patients.

MATERIALS AND METHODS: Indications for surgical tratment of SUI by ReMeEx included patients affected with not only true intrinsic sphyncteric deficency (ISD) and fixed urethra but also mild urethral hypermobility, previous incontinence surgery and relapsing conditions such as diabetes and obesity. Fifty-five female patients with severe SUI underwent ReMeEx system positioning between 1998 and 2013. Before surgery, patients were evaluated by physical examination, translabial ultrasonography, urodynamics, pad-test and compilation of a specific incontinence quality of life questionnaire.

RESULTS: Out of 55 patients treated, 50 were cured with readjustment in 10; in one case, the device was removed for infection. Complications as one transitory retention, two de novo urgency and one sovrapubic varitensor seroma were easily treated.

DISCUSSION: In our experience, the ReMeEx system produced remerkable long-term results that showed the effective role of this device in obtaining an adequate sling tension, also confirmed in a worse prognosis patient group, as reported in the present study. The limitation of this study, based on a retrospective and not comparative analysis, suggests the need for randomized prospective studies comparing the ReMeEx procedure with other similar anti-incontinence techniques.

CONCLUSIONS: ReMeEx system offers the possibility to modify the sling support whenever needed during patients' life. By this device, we can improve the outcomes of these patients leaving them completely dry without reoperations. The system produced remarkable 15 years results with a low complication rate. These outcomes have also been confirmed in a worse prognosis patient group as reported in the present study.