Adjustable Suburethral Sling (Male Remeex System^®) in the Treatment of Male Stress Urinary Incontinence: A Multicentric European Study

Abstract

Objective

To evaluate the effectiveness of a readjustable sling for the treatment of male stress urinary incontinence (SUI).

Materials and methods

Between October 2002 and August 2005, 51 male patients with mild to severe SUI were prospectively operated with the use of a readjustable sling (MRS^®) at seven different European hospitals: Spain (2), Italy (2), Greece (1), Germany (1), and Portugal (1). The origin of incontinence was radical prostatectomy in 43 cases, TUR in 4, and open prostatectomy in another 4. Duration of incontinence ranged from 1 to 10 yr with an average of 3.5 yr.

Results

All patients but 5 were regulated during the early postoperative period; 44 patients (including all 5 not regulated during the early period) required a second regulation under local anaesthesia between 1 to 4 mo after surgery, and 17 other patients required more than one delayed regulation. After that, 33 patients (64.7%) were considered cured (25 of them wore no pads at all, and 8 used small pads or sanitary napkins for security but normally remained dry); another 10 cases showed important improvement (19.6%); and only 8 patients remain unchanged (15.7%). The average follow-up time was 32 mo (range: 16–50). The mesh was removed in 1 case owing to urethral erosion and the varitensor in 2 cases owing to infection. There were five (9.8%) uneventful intraoperative bladder perforations at the postoperative period, and there were three mild perineal haematomas (5.9%). Most patients felt perineal discomfort or pain, which was easily treated with oral medications.

Conclusions

The MRS^® allowed postoperative readjustment of the suburethral sling pressure at the immediate or midterm postoperative period, which allowed the achievement of good midterm results in almost 85% of patients without significant postoperative complications.

Introduction

Moderate to severe SUI is a devastating complication that occurs in 5–12% of patients after radical prostatectomy and occasionally after surgery for benign prostatic diseases [1], [2]. In terms of quality of life, its consequences are dramatic to patients; a surgical treatment to solve it is always required [3].

Pharmacotherapy, electrical stimulation, pelvic floor exercises, and injections of bulking agents are usually ineffective in the treatment of moderate to severe SUI. Only the artificial sphincter and slings have shown good results in the treatment of this condition [4].

The Male Readjustable System^® (MRS) from Neomedic International, Barcelona, Spain, is an adjustable suburethral sling that permits effective regulation of the suburethral pressure at any time during the patient’s life. This possibility of control is always an advantage in incontinence surgery but is especially important in male SUI because of the narrow error margin between urinary retention and leakage persistency.