The results of mid-urethral slings in recurrent stress urinary incontinence or detrusor underactivity are not as promising as in uncomplicated cases. In fact, there are no clear and high grade evidence  for the management of these complicated cases.
In these cases a  problem that certainly needs to be resolved is that of the tension of the sling. In both cases, excessive or slight tension could compromise the results and also worsen the basic condition.
This study hypothesized that adjusting the tension after surgery would benefit patients with detrusor underactivity (DU) or recurrent stress urinary incontinence (SUI) after anti incontinence surgery. The aim of this study was to evaluate the long term outcomes and complications of the Remeex system in women treated in a single centre

It is a prospective study conducted from 2014 to 2023. The study was approved by Ethics Committee and patients provided written informed consent. Inclusion criteria were: age over 18 years, recurrent SUI after anti incontinence surgery, or women with SUI and DU. Exclusion criteria were:previous POP surgery; comorbidities such as diabetes or neurological disease; POP≥ stage II. Preoperative work out included: history; pelvic examination; urodynamic study, trans labial ultrasound. Patients completed self-administered UDI-6, IIQ7,FSFI. Patients were followed up at 1, 3, 6, and 12 months after surgery. At each visit, patients underwent clinical examination, evaluation of urinary and sexual symptoms, uroflowmetry with PVR measuremen.The complications was classified using both the ICS/IUGA and Clavien–Dindo classification.

25 female patients were included .They underwent to readjustable TVT (Remeex®). The mean follow up was 93±5 months. Of these 20 patients had detrusor underactivity and 5 had persistent stress urinary incontinence after TOT. The success rate was 95.3%. Two patients underwent a long-term adjustment under local anesthesia 2 years after the surgery. One patient, with detrusor underactivty  had acute urinary retention after surgery and she was treated by decreasing the tension of the varitensor. In one patient we removed the device because due to suprapubic adiposity the varitensor dislocated and the patient had pain. No events of device infection were recorded. Two patients had fever during hospitalization, but no reoperation was necessary. Bladder injury occurred intraoperatively in 2 cases.We kept the manipulator in place and the bladder catheter for 4 days, without recording infections of the device. De novo urgency is present in 5 (2.5%) patients and were treated with anticholinergics The maximum flow rate decreased significantly after the procedure (p=0.04); however, the PVR did not change significantly (p=0.07). Only 1 grade III complication according to Clavien-Dindo classification has been reported (vaginal mesh exposure2AaT3S2)

Our results are due to the ability to perform a tension free intervention reserving a readjustment in a portion of patients with complicated SUI.The long-term results are promising and the complications are low. This is due to Remeex has the dual advantage of being a sling with retropubic access, therefore it has all the long-term advantages of the TVT, and is also adjustable. The adjustment can of course be done not only to guarantee greater continence as in the case of recurrent incontinence, but also to guarantee adequate bladder emptying as in the case of detrusor hypocontractility.At the moment it is the only female sling that has this dual possibility.

Remeex is safe in women with SUI and DU, and in women with recurrent SUI, and the presence of the varitensor allows for tension regulation that could not be guaranteed otherwise.It should be guaranteed to all women with complicated urinary incontinence