Skip to main content

REMEEX — Male Readjustable Sling (MRS)

The Remeex / MRS (Neomedic; first described Sousa-Escandón 2004) is an early adjustable male sling. A suprapubic mechanical regulator (varitensor) changes tension through an external manipulator. The initial postoperative adjustment and later readjustment differ. After the external manipulator is detached, a later adjustment requires a minor procedure to reconnect it.[1][2][8]

For positioning versus other male slings, see Male Urethral Slings — chooser.

US regulatory status: The original Male Remeex System received FDA 510(k) clearance in 2006 for male stress urinary incontinence; that record does not establish clearance for the current Remeex System II.[10] Reported use includes Europe and parts of Asia. ATOMS is another adjustable option. Only indirect cohort comparisons between the two are available.

Device design​

  • Monofilament polypropylene mesh sling beneath the bulbar urethra.
  • Two monofilament traction threads pass retropubically (analogous to a retropubic female TVT trajectory) to the suprapubic region.
  • Varitensor. Permanent subcutaneous regulator over the rectus fascia approximately 2 cm above the pubis. The manipulator is used for initial tensioning and is then detached. Later readjustment requires reconnection in a minor procedure.[5][8]
  • Retropubic passage carries a bladder-perforation risk like that of retropubic female MUS, and bowel injury has been reported.[2][3]

The current generation is Remeex System II.

Surgical technique​

  1. Lithotomy; perineal incision; expose bulbar urethra.
  2. Polypropylene mesh sling positioned beneath the bulbar urethra.
  3. Open the urogenital diaphragm fascia close to the ischiopubic ramus and guide each passer from the perineal to the suprapubic incision with a fingertip in the retropubic space along the inner pubic bone. After both passes, perform cystourethroscopy to confirm urethrovesical integrity before drawing the traction threads through.[5]
  4. Draw the traction threads through the retropubic tracts, extend the sling against the bulbocavernosus muscle, and secure it with two absorbable sutures to limit movement. Connect the threads to the varitensor, implanted subcutaneously over the rectus fascia approximately 2 cm above the pubis.[5]
  5. Implant the sling without final tension. The manufacturer's product description places the first tension adjustment 24–48 hours postoperatively, with the patient standing and performing the maneuvers that provoke leakage. Intraoperative positioning or preliminary tensioning described in published variants is a separate step.[8]
  6. Cystoscopy to rule out bladder perforation from retropubic needle passage.

In the Márquez-Sánchez protocol, when no urethral or bladder perforation had occurred, the bladder was filled with 300 mL of saline at 24–48 hours and leakage was tested during cough or Valsalva after catheter removal. For persistent leakage, the manipulator was turned clockwise until leakage stopped; voiding and postvoid residual were checked before detachment.[5] Later readjustment follows a minor procedure to reconnect it. Access, anesthesia and timing follow the model IFU. The manufacturer describes readjustment as possible at any time, and the 2007 European series performed it under local anesthesia.[8]

Outcomes​

StudyNFollow-upOutcome
Sousa-Escandón 2004 (pilot)[1]618 mo83% continent; all satisfied
Sousa-Escandón 2007 (European MC)[2]5132 mo33/51 (64.7%) cured by study definition (25 pad-free, eight normally dry with a security pad); 10/51 (19.6%) improved; 43/51 (84.3%) cured or improved; 44/51 (86%) needed a second regulation under local anesthesia 1–4 mo postop
Kim 2016 (2-center)[4]6446 mo71.9% success; pads 3.42 → 0.84 (p < 0.001)
Márquez-Sánchez 2021[5]4733.5 mo42/47 (89.4%) study-defined objective effectiveness (complete or partial dryness): 34/47 (72.3%) were completely dry (0–1 safety pad/day) and 8/47 (17.0%) were partially dry (>50% pad reduction); composite effectiveness: mild 6/7 (85.7%) / moderate 20/22 (90.9%) / severe 16/18 (88.9%); 34% needed readjustment; device survival 95.7%
Chiu 2022[3]1818.4 mo mean (14 median)11/18 (61.1%) study-defined success (pad-free or normally dry with a security pad); 2 / 18 (11.1%) bowel injury during retropubic passage in this single-center cohort after transperitoneal RP
Altan 2017[6] (adjustable perineal sling with a saline tissue expander, a different device)4548 mo66.7% total success (37.8% completely dry); non-severe 57.9% vs severe 23.1% complete dry (p = 0.029)
Angulo 2021 SR/meta vs ATOMS[7]1,919 (29 studies)—REMEEX dryness 53.4% / improvement 80.2% (indirect observational estimates with substantial heterogeneity)

REMEEX vs ATOMS — indirect meta-analysis​

The Angulo 2021 meta-analysis pooled 29 observational studies without a direct comparison. Results favored ATOMS for dryness, improvement and explantation. Complications did not differ significantly. Selection, follow-up and reporting differed between cohorts:[7]

OutcomeATOMSREMEEXp
Dryness69.3%53.4%0.008
Improvement90.8%80.2%0.007
Complication18.9%35.8%0.096 (NS)
Explantation5.5%13.9%0.027

Differences persisted when restricted to current-generation devices (ATOMS SSP versus Remeex System II).

Complications​

  • Intraoperative bladder perforation: five of 51 men (9.8%) in Sousa-Escandón 2007, described as uneventful by the authors; the retropubic route is analogous to retropubic female MUS.[2] Márquez-Sánchez 2021 reported five of 47 men (10.6%) with bladder perforation during passer insertion; the passers were removed and reinserted, and implantation was completed.[5]
  • Bowel injury. Chiu 2022 reported 2/18 (11.1%, Clavien-Dindo IIIb) during sling implantation. Both slings were removed immediately after signs of bowel injury appeared, within two days of implantation. One patient then recovered with antibiotics and conservative care; the other required operative repair of two sigmoid and one ileal perforation. All patients had undergone transperitoneal RP with the peritoneum not routinely closed, and the authors proposed that bowel migration into the retropubic space contributed.[3]
  • Postoperative urinary retention occurred in 3/18 men (16.7%) in Chiu's cohort; urethral sounding or temporary catheterization was required.[3] In a separate 47-man cohort, one previously irradiated patient required implant removal for retention.[5]
  • Urethral erosion approximately 2%; varitensor infection approximately 4% requiring removal; perineal hematoma 5.9%.[2] In Chiu's separate 18-man cohort, 3/18 (16.7%) had mesh infection treated with antibiotics without mesh removal.[3]
  • Pooled explantation was 13.9%, compared with 5.5% for ATOMS (p = 0.027).[7]

Predictors of failure​

  • Prior pelvic radiotherapy. Kim 2016 reported an odds ratio of 8.4 for failure (64 men, 2 centers), and concluded that MRS suits radiation-naive men with mild incontinence.[4]
  • Higher baseline severity. OR 1.41 per pad (Kim 2016).[4]
  • Severity-related complete-dry gradient. Non-severe 57.9% versus severe 23.1% (Altan 2017, p = 0.029), a different adjustable perineal sling. Total success did not differ significantly (78.9% vs 57.7%, p = 0.135).[6]

Salvage​

When REMEEX fails, AUS is the most common salvage: 12 of 18 surgical failures in Kim 2016 received subsequent AUS.[4]

Current positioning​

Remeex offers postoperative adjustment through a suprapubic regulator. In a 2026 prospective two-center cohort, 55% of 66 men analyzed after exclusions for death or loss to follow-up achieved social continence (0–1 pad/day) at a mean 48 months; 89% underwent at least one postoperative adjustment and 6% had explantation; the authors conclude that midterm effectiveness is satisfactory in selected men with mild-to-moderate post-prostatectomy SUI.[9] The 2026 EAU guideline rates the evidence for adjustable male slings as limited (LE 3), reports no evidence that adjustability adds benefit (LE 3), and makes no recommendation for adjustable slings; it recommends offering AUS to men with moderate-to-severe SUI .[11] The 2024 AUA/GURS/SUFU guideline advises against routine male-sling implantation for severe SUI and recommends offering AUS over a sling after primary, adjuvant, or salvage radiotherapy (both Moderate Recommendations; Grade C).[12] Counseling covers retropubic implantation risks, adjustment procedures and alternatives.

See Also​

References​

1. Sousa-Escandón A, Rodríguez Gómez JI, Uribarri González C, Marqués-Queimadelos A. Externally readjustable sling for treatment of male stress urinary incontinence: points of technique and preliminary results. J Endourol. 2004;18(1):113–118. doi:10.1089/089277904322836776

2. Sousa-Escandón A, Cabrera J, Mantovani F, et al. Adjustable suburethral sling (Male Remeex System) in the treatment of male stress urinary incontinence: a multicentric European study. Eur Urol. 2007;52(5):1473–1479. doi:10.1016/j.eururo.2007.05.017

3. Chiu LW, Chen WC, Hsieh PF, Chen YH, Huang CP. Efficacy and complications of the re-adjustable male sling system for stress urinary incontinence after radical prostatectomy. J Clin Med. 2022;11(22):6764. doi:10.3390/jcm11226764

4. Kim SW, Walsh R, Berger Y, Kim JH. Male readjustable sling (MRS) system for postprostatectomy incontinence: experiences of 2 centers. Urology. 2016;88:195–200. doi:10.1016/j.urology.2015.10.016

5. Márquez-Sánchez GA, Padilla-Fernández BY, Perán-Teruel M, et al. Remeex system effectiveness in male patients with stress urinary incontinence. J Clin Med. 2021;10(10):2121. doi:10.3390/jcm10102121

6. Altan M, Asi T, Bilen CY, Ergen A. Adjustable perineal male sling for the treatment of urinary incontinence: long-term results. Urology. 2017;106:216–220. doi:10.1016/j.urology.2017.04.030

7. Angulo JC, Ruiz S, Lozano M, et al. Systematic review and meta-analysis comparing adjustable transobturator male system (ATOMS) and male readjustment mechanical external (REMEEX) system for post-prostatectomy incontinence. World J Urol. 2021;39(4):1083–1092. doi:10.1007/s00345-020-03300-1

8. Neomedic. Remeex Male product description and adjustment sequence. Manufacturer page (accessed September 2026). This is not the complete model IFU.

9. Maene A, Righini M, Cabaniols L, et al. "Adjustable retropubic sling (Remeex®) for the treatment of male stress-urinary-incontinence after prostatectomy: Middle-term results and patient satisfaction." Fr J Urol. 2026;36(4):103074. doi:10.1016/j.fjurol.2026.103074

10. US Food and Drug Administration. Male Remeex System: 510(k) K062341, Indications for Use. 2006. FDA clearance record; indications.

11. European Association of Urology. EAU Guidelines on the Management of Non-neurogenic Male LUTS. EAU Guidelines Office; 2026. §§5.6.5.b.2, 5.6.5.c.1. Disease management.

12. Breyer BN, Kim SK, Kirkby E, Marianes A, Vanni AJ, Westney OL. "Updates to Incontinence After Prostate Treatment: AUA/GURS/SUFU Guideline (2024)." J Urol. 2024;212(4):531–538. doi:10.1097/JU.0000000000004088