title: Severe complications and failures of incontinence surgery using the Remeex(®) adjustable tension sling (external mechanical regulator).
abstract: OBJECTIVE
  Since 1999, we have performed implantations of Remeex® adjustable prosthetics as rescue treatment for complex or persistent stress urinary incontinence (SUI) after failure of other surgical treatments (Burch colposuspension, Marshall-Marchetti-Krantz (MMK) or tension-free transvaginal tape [TVT] until 2003 and transobturator tape [TOT] since 2003). We present the results of our series, which include cases with severe complications.
  
  
  METHODS
  Retrospective study of women diagnosed with complex or refractory SUI who underwent Remeex(®) implantation between October 1999 and December 2013. In 5 cases, we conducted cystocele correction in the same operation as the placement of the Remeex(®).
  
  
  RESULTS
  Sixty women, with a mean age of 66.87 years (range 39-85), underwent operations. The procedure was successful in 68.33% of the cases. The failures consisted of the following: 10% of the women had mixed urinary incontinence (UI) with multiple bladder diverticula; 8.33% had mild SUI; and 13.33% had urgency urination without UI. Thirty-five percent required adjustments. We recorded 3 cases with severe complications: disabling severe UI in a patient who underwent multiple operations, massive pelvic hemorrhage in a patient undergoing standard antiplatelet therapy and infected vaginal calculi measuring 7cm on an extruding Remeex thread in a paraplegic patient 4 years after the implantation.
  
  
  CONCLUSIONS
  Remeex(®) is an effective and safe procedure for achieving continence in cases of complex or refractory SUI, although it is not exempt from severe complications. Following rigorous protocols can help detect complications and treat them in a timely manner.
authors.affiliation: Servicio de Urología, Complejo Asistencial Universitario de Salamanca, Salamaca, España; Departamento de Cirugía, Universidad de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España. Electronic address: mflorenzogo@yahoo.es.
authors.forename: M F
authors.initials: MF
authors.lastname: Lorenzo-Gómez
authors.affiliation: Servicio de Urología, Complejo Hospitalario Universitario de Canarias, Tenerife, España.
authors.forename: B
authors.initials: B
authors.lastname: Padilla-Fernández
authors.affiliation: Servicio de Urología, Complejo Asistencial Universitario de Salamanca, Salamaca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España.
authors.forename: A J
authors.initials: AJ
authors.lastname: Virseda-Rodríguez
authors.affiliation: Servicio de Ginecología y Obstetricia, Hospital San Rafael, Madrid, España.
authors.forename: R E
authors.initials: RE
authors.lastname: Collazos-Robles
authors.affiliation: Departamento de Cirugía, Universidad de Salamanca, Salamanca, España.
authors.forename: M B
authors.initials: MB
authors.lastname: García-Cenador
authors.affiliation: Departamento de Medicina Preventiva y Salud Pública, Universidad de Salamanca, Salamanca, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Mirón-Canelo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011474:Prosthesis Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D053825:Suburethral Slings / Q000009:adverse effects*; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods
keywords: Complicaciones; Complications; Incontinencia urinaria; Remeex(®); Urinary incontinence