Prostate cancer is the second most commonly diagnosed cancer in men, with an estimated 1.1 million diagnoses worldwide in 2012, accounting for 15% of all cancers diagnosed. The incidence of PCa diagnosis varies widely between different geographical areas, having in Western Europe age-standardised rates per 100,000 of 94.9 (1). Post-prostatectomy incontinence is a common problem following surgery for prostate cancer. Recent systematic reviews have reported that the mean continence rates at twelve months were 89-100% for patients treated with robot-assisted laparoscopic prostatectomy and 80-97% for patients treated with open retropubic radical prostatectomy (1). The figures of urinary incontinence after radiation therapy are not well established, and vary according to the treatment modality (3D-CRT, IMRT, brachytherapy).
There is a wide surgical armamentarium for the management of post-prostatectomy incontinence, including artificial urinary sphincter, transobturator male slings, self-anchoring adjustable transobturator male system, and readjustable retropubic male sling with a suprapubic varitensor that makes possible to adjust the tension of the device, externally, under local anesthesia at any moment from device implant (MRS Remeex® system).
We investigate the cure rate of patients with urinary incontinence after different teratment modalities due to prostate cancer who underwent surgery with the MRS Remeex® system.

Multicentric retrospective study of a sample of 160 patients with urinary incontinence treated with the MRS Remeex® system after prostate cancer treatment. 
Study groups: 
* Group A (n=95): patients with urinary incontinence secondary to radical prostatectomy.
* Group B (n=47): patients with urinary incontinence secondary to radical prostatectomy plus radiation therapy.
* Group C (n=18): patients with urinary incontinence secondary to radiation therapy.
VARIABLES: Age. BMI. PSA. pTNM. Urinary incontinence grade, urodynamic study (UDS). Urinary incontinence surgery results. SUI evolution time in months. Secondary diagnoses. 
Descriptive statistics, Student’s T, Fisher’s exact test were performed; p<0.05 is considered significant.

Mean age was 70.02 years old for the whole sample (SD 7.31, median 71, range 45-86), being higher in group C. No differences were found between groups for body mas index, pTNM and Gleason score. 
Urodynamic studies reported that patients in group B had a lower bladder capacity with poor compliance, and that these results were associated with a worse result. 
Diabetes mellitus type 2 was associated with a worse result in all groups. 
Total continence without the use of pads was achieved in 85 patients in group A (89.47%), 35 patients in group B (74.46%) and 15 patient in group C (83.33%). 
In follow-up visits, 89 patients required readjustments (55.62%), and 71 patients did not require readjustment with a mean follow up of 24 months (range 6-48 months).

Artificial urinary sphincter is nowadays considered the gold standard for the management of severe stress urinary incontinence in males with a high success rate. However, device's operating might be difficult in patients with impaired cognitive function or decreased manual dexterity (2). Furthermore, recent studies suggest that prior radiation therapy may predict earlier reoperation in patients with artificial urinary sphincter and a higher complications rate (3).
The results show that  the MRS Remeex® system is highly effective in the treatment of male urinary incontinence, reaching a 89% cure rate in non-radiated patients. It is also highly effective after radiation therapy (83%), and this is an important fact compared to artifical urinary sphincter.  The best results are achieved when bladder compliance and capacity are not affected, confirming the device's strong control of the urethra. Thus it is important to diminish treatments' adverse events on the bladder (i.e., poor compliance due to radiation therapy) or bladder dysfunction due to other comorbidities (i.e., diabetes mellitus and neurogenic bladder). These results persisted in the long-term.

Among the devices to correct urinary incontinence after prostate cancer treatment, MRS Remeex® system with the readjustable suburethral tape shows good continence rates in situations of bad prognosis,  such as radiation therapy, severe urinary incontinence or incontinence of long evolution time, comparable to reference devices like the artificial urinary sphincter.

N. Mottet, R.C.N. van den Bergh, E. Briers, L. Bourke, P. Cornford, M. De Santis, S. Gillessen, A. Govorov, J. Grummet, A.M. Henry, T.B. Lam, M.D. Mason, H.G. van der Poel, T.H. van der Kwast, O. Rouvière, T. Wiegel. G.Associates: T. Van den Broeck, M. Cumberbatch, N. Fossati, T. Gross, M. Lardas, M. Liew, L. Moris, I.G. Schoots, P.M. Willemse. EAU-ESTRO-ESUG-SIOR guidelines on Prostate Cancer, 2018. Available at http://uroweb.org/guideline/prostate-cancer/
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