Adjustable retropubic sling (Remeex®) for the treatment of male stress-urinary-incontinence after prostatectomy: Middle-term results and patient satisfaction.

OBJECTIVE

To evaluate the mid-term outcomes of the adjustable retropubic sling (Remeex®) in the treatment of post-prostatectomy stress urinary incontinence (PPUI) in men.

METHODS

This prospective bicentric observational study was conducted at two French tertiary centers between December 2016 and December 2024. Sixty-six men with persistent PPUI were included after exclusion of deaths and loss to follow-up. Patients were selected based on incontinence severity, failure of pelvic floor rehabilitation, and informed preference. Outcomes were assessed using the 24-hour pad test, social continence (0-1 pad/day), Patient Global Impression of Improvement, and complication rates. The primary endpoint was social continence at mid-term follow-up.

RESULTS

After a mean follow-up of 48months, social continence (0-1 pad/day) was achieved in 55% of patients. A≥50% improvement in the 24-hour pad test was observed in 71% of patients. The mean pad test weight significantly decreased from 218.7g preoperatively to 98.1g postoperatively (P<0.05). Postoperative adjustability was frequently required, with 89% of patients undergoing at least one adjustment and a mean of two adjustments per patient, mainly within the first six months. Complications were limited, with no urethral erosion and an explantation rate of 6%.

CONCLUSION

The Remeex® adjustable retropubic sling demonstrated acceptable safety and satisfactory mid-term effectiveness in selected patients with mild to moderate PPUI. Postoperative adjustability represents an inherent component of the technique and should be anticipated during patient counseling.