title: Midterm efficacy and complications of readjustable midurethral sling (Remeex system) in female stress urinary incontinence with recurrence or intrinsic sphincter deficiency.
abstract: OBJECTIVE
  To evaluate the efficacy, complications, and managements of the readjustable midurethral sling (Remeex system) for the treatment of recurrent stress urinary incontinence (SUI) after previous anti-incontinence surgeries or intrinsic sphincter deficiency (ISD).
  
  
  METHODS
  Between March 2008 and February 2012, 102 women, who presented with previous failed surgery or ISD, were treated with the Remeex system at 4 different institutions. We retrospectively reviewed medical history, physical examination, urodynamic study, postvoiding residual volume, and/or 1-hour pad test of the patients. Surgical outcomes were evaluated using the Severity Index for Urinary Incontinence. The degree of patient satisfaction was assessed, and all complications were classified according to the modified Clavien classification system.
  
  
  RESULTS
  After a mean follow-up of 27.6 months (range, 14-56 months), 91 patients (89.2%) were cured and 6 patients (5.9%) were improved. The patient's satisfaction rate was 87.2% (89 of 102 patients). Overall, 41 patients (40.2%) experienced 53 complications; 15 patients (14.7%) presented de novo urgency, which was properly managed with anticholinergics, and 14 patients (13.7%) underwent delayed sling readjustment for recurrent SUI (n = 13) and urinary retention (n = 1) during follow-up. Among 6 patients (5.9%) with wound infection, 4 patients were successfully treated by daily dressing with antibiotics, and 2 patients underwent removal of the Remeex system owing to intractable infection. Most complications were classified as grade 1 (54.8%) or 2 (15.1%) and were successfully treated with minimal conservative measures.
  
  
  CONCLUSIONS
  The Remeex system is a valuable adjunct for recurrent SUI after previous anti-incontinence surgeries or ISD, considering most complications are Clavien grade I or II.
authors.affiliation: Department of Urology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
authors.forename: Bong Hee
authors.initials: BH
authors.lastname: Park
authors.affiliation: Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
authors.forename: Joon Chul
authors.initials: JC
authors.lastname: Kim
authors.affiliation: Department of Urology, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hyun Woo
authors.initials: HW
authors.lastname: Kim
authors.affiliation: Department of Urology, Soonchunhyang University Hospital, College of Medicine, Soonchunhyang University, Bucheon, Korea.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Urology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jong Bo
authors.initials: JB
authors.lastname: Choi
authors.affiliation: Department of Urology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. Electronic address: dhluro@hanmail.net.
authors.forename: Dong Hwan
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011474:Prosthesis Design; D012008:Recurrence; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D013997:Time Factors; D014522:Urethral Diseases / Q000209:etiology; D014550:Urinary Incontinence, Stress / Q000601:surgery*