Mid-term evaluation of the safety and efficacy of the Remeex re-adjustable sling for recurrent stress incontinence and intrinsic sphincteric deficiency.Carlos Errando, Carlos Báez, Manel Prados, Cristina Gutiérrez, Pedro Araño, Humberto VillavicencioFundació Puigvert, Barcelona, Spain.Introduction and objectivesTension-free tapes are the first choice for treatment of stress incontinence (SUI) with hypermobile urethra. However, results are not as reliable in recurrent cases or in patients with intrinsic sphincter deficiency (ISD). We present our results with the Remeex re-adjustable sling system. The Remeex system consists of a 3 cm polypropylene sling with 2 prolene sutures that connect to a prosthesis (varitensor) placed over the rectus fascia. An adjustment arm (manipulator)exits the skin for 1-2 days allowing for tightening or loosening of the sling. The sling is placed tension free at surgery, the initial adjustment being performed the following day based on cough and pad testing. Once the tension is adjusted, the manipulator is withdrawn. The varitensor can be accessed in the long-term in an ambulatory setting under local anesthesia if subsequent adjustment (tighter or looser) is necessary.Methods125 patients classified by clinical criteria Q-tip and urodynamics, into ISD (70 cases) and recurrent hyper-mobility SUI (55 cases) underwent the Remeex procedure. Outcome measures included urodynamic assessment of cure, and the King´s Health Questionnaire.ResultsAfter a mean follow-up period of 32 months (range: 26-52), 109 patients (87.2%) are objectively cured of stress incontinence. Nine (7.2%) additional patients were satisfied and refused re-adjustment, and the remaining 7 (5.6%) patients are on the waiting list for re-adjustment. Nineteen patients (15.2%) showed some evidence of urge incontinence(9 with previous urodynamic mixed incontinence, and 10 with de-novo detrusor overactiviy incontinence). Twenty-one of the 109 successes (19.2%) required adjustment of the sling months after the initial procedure. The ability to adjust the sling enabled us to convert failures into cures. The tension was increased in 17 cases due to recurrence of SUI after a mean period of 12 months, and reduced in 4 cases due to obstruction. The varitensor was withdrawn in one case due to infection but continence was preserved. Bladder perforation during needle passage was seen in 15 patients. No other adverse events or complications were seen.ConclusionsThe Remeex adjustable sling system provides a good cure rate for recurrent SUI and ISD with a low complication rate. The correct sling tension is easily achieved during the early postoperative period. When necessary, one is able to convert failures into cures. Increasing and decreasing the sling tension was successful in achieving clinical improvements. The problems of obstruction and recurrent incontinence during the follow up period were resolved successfully in every case.
本文来源：https://www.2haoxitong.net/k/doc/ea483c17650e52ea55189817.html
