Conventional surgery for female stress incontinence is usually successful but recurrent cases are difficult to treat. This study of 20 such cases treated by the Remeex TRT system shows symptomatic benefit up to 5 years following insertion of the device. The benefit of this procedure is that the sling can be adjusted to the correct tension in the optimum leak position and circumstances, and anytime thereafter without the need to repeat the entire operation. As a result, the voiding dysfunction rate and need to intermittent self-catheterise is reduced, even with a low pressure urethra. The cost per procedure and complication rate is higher that standard TVT, and the device may occasionally need removal due to persistent seroma. However, the improved quality of life makes this operation an attractive option in recurrent cases of female stress incontinence.

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In this article, the authors explore the impact of modifiable factors such as smoking, alcohol and substance abuse on male reproductive health.

Ankylosing spondylitis (AS) is associated with an increase in cardiovascular (CV) morbidity when compared to the general population. The increased risk of CV involvement in AS is likely multifactorial including inflammation accelerating atherosclerosis and the cardiac inflammation itself in the form of aortitis and conduction anomalies. Establishing indisputable evidence linking AS and CV disease is challenging due to AS being relatively rare and it affects 1:1,000 and all studies analyzing the association between AS and CV disease involve a small sample size making long-term outcome measurements limited. The article reviews the literature studying the association between AS and CV disease as well as the impact of therapies for AS on the CV system (CVS).

Introduction and hypothesis This study reports the long-term anatomic and subjective outcomes following sacrocolpopexy based on mesh weight and provides device-specific data. Methods This cohort study compared ultra-lightweight (≤ 20 g/m 2 ) with lightweight mesh (≥ 25 g/m 2 ). The primary outcome was composite failure defined as at least one of ≥ stage 2 apical prolapse, anterior or posterior vaginal wall beyond hymen, complaint of bulge or retreatment. Effect measure estimates were calculated as the incidence rate ratio of composite failure comparing the use of ultra-light with lightweight mesh. Crude and adjusted incidence rate ratios (IRRs) were obtained using uni- and multivariable Poisson regression models. Results Of 358 women who met inclusion criteria, 220 (61%) agreed to attend for review; 95 (43%) had ultra-lightweight mesh and 125 (57%) had lightweight mesh including Upsylon TM . Median follow-up for ultra-light and lightweight mesh was 36 (IQR 22–42) and 63 (IQR 48–87) months, respectively ( p < 0.001). Accounting for differences in follow-up time, there was no significant difference in composite failure between ultra-light and lightweight mesh groups (IRR 1.47, 95% CI 0.83–2.52, p = 0.15). This persisted after adjustment for age, body mass index, parity, smoking and presence of advanced prolapse prior to surgery (IRR 1.52, 95% CI 0.94–2.47, p = 0.087). Mesh exposure for both groups was mostly asymptomatic, and the rate was 7% for the ultra-light group and 8% in the lightweight group. Overall, repeat surgery for recurrent apical prolapse and mesh exposure occurred in 4% and 2%, respectively. Conclusions Ultra-lightweight mesh appears to have similar incidence rate of failure compared to lightweight mesh. Upsylon TM mesh has a similar low rate of recurrent apical prolapse and mesh exposure. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-022-05182-w.