To evaluate the efficacy and safety of adjustable TVT (Tension-free Vaginal Tape) procedure for treatment of complicated SUI (Stress Urinary Incontinence) in women, which has a high probability of failure if using classical methods of mid-urethral sling such as TVT and TOT (Trans Obturator Tape).

This is a case series study, conducted at the Department of Functional Urology, Ho Chi Minh city University Medical Center. Selected patients were complicated SUI cases in women. 
Complicated SUI means a high probability of failure if standard TVT, TOT techniques are applied, in particular if at least one of the following factors is present: 1) intrinsic sphinter deficiency; 2) non urethral hypermobility ; 3) prehistory of surgical treatment for SUI that failed. 
Sling used was Adjustable Sling of AMI company (Austria). 
Technique of placing sling is according the principle of TVT. Adjust sling tension early if the patients still have urinary incontinence or difficulty of urination

From October 2020 to December 2022, 23 women with complicated SUI were operated by adjustable TVT technique, with a mean age of 57.8 years old (min = 44, max = 78). 
Mean operating time was 42 minutes (min = 35, max = 70). Mean follow-up was 11.9 months (min = 3, max = 28). 5 cases had to adjust the tension of sling after surgery: 5 times to decrease the tension due to difficulty urinating or urinary retention after removing the catheter, 3 times to increase the tension due to stress urinary leakage and (2 patients had to adjust 2 times, another one had to adjust 3 times). 
At the last follow-up visit: 20/23 patients had no urinary leakage (3 of them had mild difficulty urinating) 3/23 patients had mild urinary incontinence but significant improvement, none of them showed mesh erosion.

The successful rate of this method is quite high (86.9%), even when applied to complicated SUI. 
We note that the action of adjustment should be done in the first week after surgery. After this time, it will be very difficult because the sling is already adhered by the fibrous tissue formation

Adjustable TVT is a safe, effective, fairy easy method for treatment of complicated SUI in women, which can help to reduce failure rate compared to conventional methods of mid-urethral sling. 
Our number of patients is still small and the follow-up time is not too long, so we will continue to minitor this topic to get more accurate conclusions

Schmid C, Bloch E, Amann E, et al (2010). “An Adjustable Sling in the Management of Recurrent Urodynamic Stress Incontinence after Previous Failed Midurethral Tape. Neurourology and Urodynamics 29: 573–577
Giberti C, Gallo F, Cortese P, Schenone M (2011). “The suburethral tension adjustable sling (REMEEX system) in the treatment of female urinary incontinence due to ‘true’ intrinsic sphincter deficiency: results after 5 years of mean follow-up. BJU Int; 108: 1140-4
Kim WB , Lee SW , Lee KW, et al (2019). “Readjustable midurethral sling (REMEEX system) in obese women”. Investig Clin Urol; pISSN 2466-0493 • eISSN 2466-054X