Stress urinary incontinence is the involuntary loss of urine with increased intra-abdominal pressure. It is a very prevalent pathology that predominantly affects the female sex. It has a significant impact on her quality of life, and a high economic impact on the health system.

Initial treatment is based on lifestyle interventions. However, most patients especially those with moderate-severe symptoms, will require surgical treatment. Tension free transobturator tapes has become the most popular surgical option due to its comfortable technique and few complications.

However, this is not a risk-free technique, like the relatively common sling extrusion. This fact leads to the reappearance of alternatives, such as autologous rectus fascial sling, especially indicated for complex and refractory cases of stress urinary incontinence.

We expose the clinical case of a 59-year-old woman with a history of smoking, arterial hypertension and dyslipidemia. 

Under urological follow-up for long-standing stress urinary incontinence. In 2012, she underwent surgery for the placement of a transobturator tape that had to be removed due to overcorrection. In 2017, she underwent surgery for the placement of another transobturator tape that had to be removed due to sling extrusion. In 2021, when she comes to our center, we decide to place an adjustable autologous rectus fascial sling with the Remeex® system.

There were no complications during surgery. Although it is an adjustable device, in our case it was not necessary to adjust the tension of the system, because in the review before giving our patient the hospital discharge, she had no urine leaks or voiding difficulties.

In the last review, 9 months after the surgery, the patient is very satisfied with the results (treatment benefit scale). She does not need pads or diapers because she does not have leaks or voiding difficulties. Uroflowmetry with maximum flow rate of 15ml/s, voided volume of 166cc, without relevant post void residual.

The adjustable autologous fascial sling is a valid option for complex, severe or recurrent cases of stress urinary incontinence. It is a relatively simple surgical technique with proper results and a low risk of complications.