Hospital: University of Illinois at Chicago (UIC), USA
If you had to say in which cases Remeex has provided you with a unique solution, in which ones would be?
“Yes, Remeex helps me to deal with very complicate patients. Those patients with ISD are very difficult to manage as the limit between continence and incontinence is very small, with Remeex I can be very precise and apply the tension needed for each patient and no more. For recurrent patients, I find the adjustability very useful, with other solutions you must guess the tension.”
What is your experience treating patients with previous failed MUS?
“Yes, I don’t want to take the risk to use another MUS and fail again. Remeex is lifetime adjustable, so I know every time patients come back to my office leaking I will be able to manage by adjusting the tension to their needs.”
Are you afraid of tighten to much the sling and drive the patient into retention?
“This is the main limitation we have with tension free slings, tension or support that the sling will give to the urethra is not 100% predictable as sling can suffer of retraction due to body interaction or even elongation loosing urethral support. With Remeex the tension is applied at the post-op adjustment with the patient awake helping me in order to apply the correct tension. However, in the event of having the patient under retention I can release tension as well. This procedure is extremely easy and intuitive and can be repeated anytime.”
Do you have adverse events? If so, are they difficult to solve?
“I have similar complications and similar rate as regular MUS. On regards erosion and retention complications, I have to explain that Remeex has a very unique Dynamic Pressure Transmission System that reduces both risks. It works as a closed system, connecting the sling (urethra) with the varitensor (abdomen), at rest acts almost like a tension free sling and only applies extra tension when it’s needed (increase of the abdominal pressure). As a conclusion, the system is not compressing the urethra all the time, avoiding erosion and retention problems, but applies extra tension to keep patients dry when needed.”
What about infection risk?
“I’m not concerned about infections. I have a very useful protocol to avoid them and my infection rate is very low, similar to the MUS.”
What do you do in the event of infection?
“That’s a good question, if the infection is around the sling, as remeex has the smallest sling in the market it’s the easiest to remove. If the infection is in the varitensor (abdominal area), I normally remove the varitensor and make a knot with the sutures. I try to not change the tension as patients are continent even though they are suffering from this infection. So, I solve the infection but In most of the cases keep them dry.”
How do you adjust the tension of a patient that has had the surgery many years ago?
“This is a very simple procedure performed under local anesthesia. The implant is under the skin 1 cm over the pubic bone and we have to look for this part, very simple dissection. Once the system is connected we will perform the same adjustment procedure as we do during adjustments at post-op. Fill bladder, Valsalva maneuvers and tension it as needed until continence point.”
How is this possible after years of the device implantation?
“It is possible because the fibrosis created is small as the sling and it will be only under the urethra. As we don’t have tissue ingrowth all the way through the retropubic space, only thread that gets encapsulated and not fixed with fibrotic tissue, this is why we can adjust it at long term. I know a colleague that did this procedure after 16 years the sling was implanted and it worked as the system was placed a few days ago.”
Would you recommend to use Remeex to your colleagues?
“Definitely yes, I think it’s a very unique solution that helps in those complicate patients. It’s easy as a TVT to implant, safe and easy to manage the patients at long-term thanks to the lifetime adjustability.”