Surgical treatment of urinary stress incontinence using a method for postoperative adjustment of sling tension (Remeex System)

We present a technique that allows postoperative adjustment of the sling tension in female patients with urinary stress incontinence (USI). Twenty-one female patients with urodynamically proven USI were prospectively evaluated. Subjective and objective evaluation was made preoperatively, 6 months postoperatively and yearly thereafter. Mean age was 63.5; mean parity was 2.3. All patients were postmenopausal and 13 (62%) had had previous surgery for USI. The operating time was 32 minutes (range 25–45). At a mean follow-up of 12 months (6–25), 19 patients (90.5%) were very satisfied. Two patients (9.5%) were considered failures but subjectively were satisfied and refused readjustment. One patient (4.7%) developed 'de novo' detrusor instability. In conclusion, this is a sling procedure for patients with previous failed surgery and those with intrinsic sphincter deficiency (ISD) with the peculiarity that the sling tension can be regulated postoperatively. The readjustment can be made in the office, months or even years after the procedure.Abbreviations USI Urinary stress incontinence - ISD Intrinsic sphincter deficiency - MUCP Maximum urethral closure pressure - VLPP Valsalva leak-point pressureEditorial Comment: Adjusting the sling tension of a bladder neck sling at the time of surgery is diffucult and not very scientific. Slings that are too tight are associated with voiding dysfunction and De Novo urge incontinence. Slings that are too loose may still allow stress incontinence. This sling system allows the surgeon to leave very loose at the time of surgery with the ability to tighten or loosen the sling easily in the post-operative period to achieve continence and still maintain adequate voiding function. Data on long term success or need for surgical removal is not available. The ability to tighten or, more importantly, loosen this sling at a later time in the post-operative period when scarring has occured is not known at present.