Mid-term results of the Remeex® readjustable sling for female complex stress urinary incontinence and sonographic hypomobile urethra

Ros, Cristina; Escura, Sílvia; Anglès‐Acedo, Sònia; Larroya, Marta; Bataller, Eduardo; Amat, Lluís; Sánchez, Emília; Espuña‐Pons, Montserrat; Carmona, Francisco

doi:10.1007/s00192-021-04972-y

Cited by 4 publications

(6 citation statements)

References 31 publications

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“…A hypomobile urethra seems to be a relevant risk factor for MUS failure, impeding urethral kinking (concordant movement) between the sling and the urethra due to lack of contact 2,13 . In patients with SUI and sonographic hypomobile urethra, the RAS procedure demonstrated improvement of symptoms of SUI in this group of complex SUI patients 6 . Finally, bladder neck funneling might involve the potential coexistence of ISD, 22 as shown in our sample, and should be taken into account in the presurgical evaluation.…”

Section: Discussionmentioning

confidence: 77%

“…2,13 In patients with SUI and sonographic hypomobile urethra, the RAS procedure demonstrated improvement of symptoms of SUI in this group of complex SUI patients. 6 Finally, bladder neck funneling might involve the potential coexistence of ISD, 22 as shown in our sample, and should be taken into account in the presurgical evaluation.…”

Section: Discussionmentioning

confidence: 78%

“…Therefore, an exhaustive presurgical workup including PF-US is highly recommended to assess the different patient profiles in order to select the most suitable sling for each woman, with the RAS being among the options of surgical treatment in women with complex SUI. 5,6 Due to the differences in the complexity and also the basal UI severity of patients treated with RAS and those treated with MUS, the expectations of cure are different and surgical success rates could not be compared. In the present study, only sonographic parameters were compared because the sonographic pattern of the MUS as well as its correlation with symptoms and complications are well established in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…In both Urogynecology Units, the first option is MUS in patients with SUI with surgical indication and normal or hypermobile urethra determined by pelvic floor ultrasound (PF‐US). Conversely, RAS is an option for a selected group of patients with complex SUI and hypomobile urethra assessed by physical examination and ultrasound 6 . Although the surgical placement of the RAS and the RT‐MUS is similar at the suburethral level, the suprapubic device that closes the RAS system allows it to be more obstructive than the RT‐MUS.…”

Section: Methodsmentioning

confidence: 99%

“…Conversely, RAS is an option for a selected group of patients with complex SUI and hypomobile urethra assessed by physical examination and ultrasound. 6 Although the surgical placement of the RAS and the RT-MUS is similar at the suburethral level, the suprapubic device that closes the RAS system allows it to be more obstructive than the RT-MUS.…”

Section: Patientsmentioning

confidence: 99%

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Readjustable Sling in Women With Stress Urinary Incontinence and Hypomobile Urethra: Understanding the Mechanisms of Closure by Transperineal Ultrasound

Ros

Escura

Anglès‐Acedo

et al. 2022

J of Ultrasound Medicine

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Objectives To assess the postsurgical sonographic parameters of a readjustable sling (RAS) according to urinary incontinence (UI) symptoms after surgery and compare this RAS sonographic pattern with mid‐urethral slings (MUS). Methods Observational, prospective multicenter study, including women undergoing stress urinary incontinence (SUI) surgery with RAS (Remeex®). The primary outcome was the association between UI symptoms and sonographic parameters measured by two‐dimensional transperineal and high‐frequency endovaginal ultrasound. We measured static parameters (bladder neck funneling, RAS position, symmetry, distance to the urethral lumen), and the movement of the sling on Valsalva. UI symptoms were measured with the postsurgical Incontinence Questionnaire‐Short Form (ICIQ‐UI‐SF) questionnaire. We created two control groups including patients with transobturator‐MUS (TOT‐MUS) and retropubic‐MUS (RT‐MUS) to compare postsurgical sonographic parameters of RAS with MUS. Results Among the 55 women with RAS included, the postoperative ICIQ‐UI‐SF scores were significantly higher in patients with bladder neck funneling (15.0 (3.9) vs 10.6 (6.7); P = .020) and in those with discordant movement of RAS on Valsalva (14.6 (5.7) vs 10.3 (6.7); P = .045). Compared with the 109 women with TOT‐MUS and the 55 with RT‐MUS, RAS was more often located in the proximal urethra and farther from the urethral lumen. Conclusions Postsurgical pelvic floor ultrasound demonstrated that in women with complex SUI and hypomobile urethra who underwent RAS (Remeex®) surgery, the presence of bladder neck funneling and discordant movement on Valsalva correlate with the persistence of UI symptoms. In these women, RAS is more often located in the proximal urethra and farther from the urethral lumen at rest in comparison with MUS.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

See 3 more Smart Citations

Readjustable Sling in Women With Stress Urinary Incontinence and Hypomobile Urethra: Understanding the Mechanisms of Closure by Transperineal Ultrasound

Ros

Escura

Anglès‐Acedo

et al. 2022

J of Ultrasound Medicine

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Aplicabilidad clínica de la ecografía de suelo pélvico en las mujeres con disfunciones miccionales

Sancho

Cerro

Acedo

et al. 2022

Clínica e Investigación en Ginecología y Obstetricia

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The evolution of stress urinary incontinence treatment techniques of the last three decades

Riccetto

2022

Int. braz j urol.

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The authors retrospectively studied a database of 221 patients who underwent correction of stress urinary incontinence (SUI) through the implantation of a SAFYRE VS retropubic sling (96 women) or a homemade polypropylene retropubic sling -HMS (125 patients) between March 2005 and December 2007, comprising a median follow-up of 78.47 (± 38.69) months (1). The evaluation included a telephone call made by a blinded trained researcher for those patients who had completed at least one year of surgery. The HMS was made of a 75g/m 2 , 15mm-wide polypropylene mesh attached with polyglycolic acid sutures at its edges. Both HMS and SAFYRE VS groups presented significant improvements on International consensus on Incontinence -Urinary Incontinence Short Form questionnaire (ICIQ-UI SF) and there were no differences in satisfaction, subjective cure rates, ICIQ-UI SF, or complications between groups, but a significantly higher frequency of patients of SAFYERE VS group required indwelling urinary catheter over 24 hours ( 2.4% vs. 8.3%, p=0.061) as well as a higher frequency of bladder injury was observed in the SAFYRE VS group (0% vs. 4.2%, p=0.034).In the present study (1), the use of the SAFYRE VS was not advised for patients with severe or recurrent SUI or those with expected need of postoperative readjustment that are the primary population for which readjstuble sinthetic slings have been currently proposed (2, 3). In fact, authors disclosured that the allocation of patients for HMS or SAFYRE VS implant was exclusively conditioned to their availability at the time of surgery. Furthermore, no significant sociodemographic or clinical differences were detected between patients in both groups, which allowed for reasonable data comparison despite the retrospective and non randomized study design.In fact, there are few publications focused on both types of suburethral slings which were studied in the current series. The SAFYRE VS sling kit developed in Latin America, and together with REEMEX readjustable System (Neomedic Int, Spain) correspond to the only two slings that propose to allow an easy postoperative readjustment feature (4). However, publications on long-term follow-up are rare for both devices so the present series is a good reference on the performance of SAFYRE VS in longer follow--up periods than previously published (refer to article's references).Publications about homemade polypropylene slings are even rarer and much more difficult to evaluate, due to the biomechanical differences and the wide range of of the meshe's size resulted from the surgeon's tailoring. In addition, detailed descriptions of the procedures used for the primary adjustment and sling fixation are often missed in the publications (5), leaving no answer as to how it should be performed, i.e., if similar to the adjustment of a classic aponeurotic sling or as the same manner as used for polypropylene midurethral slings sets.

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Mid-term results of the Remeex® readjustable sling for female complex stress urinary incontinence and sonographic hypomobile urethra

Cited by 4 publications

References 31 publications

Readjustable Sling in Women With Stress Urinary Incontinence and Hypomobile Urethra: Understanding the Mechanisms of Closure by Transperineal Ultrasound

Readjustable Sling in Women With Stress Urinary Incontinence and Hypomobile Urethra: Understanding the Mechanisms of Closure by Transperineal Ultrasound

Aplicabilidad clínica de la ecografía de suelo pélvico en las mujeres con disfunciones miccionales

The evolution of stress urinary incontinence treatment techniques of the last three decades

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