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REMEEX — Male Readjustable Sling (MRS)

The Remeex / MRS (Neomedic; first described Sousa-Escandón 2004) is the earliest adjustable male sling and the only one with truly non-invasive percutaneous re-tensioning — the suprapubic mechanical regulator (varitensor) is activated by an external screwdriver-like manipulator under local anesthesia, with no incision or port access required.[1][2]

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

Not FDA-approved in the US; remains in use primarily in Europe and parts of Asia. Largely superseded by ATOMS in centers with access to both.

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 ~ 2 cm above the pubis. Tension is increased or decreased percutaneously with the external manipulator at any time post-op.[2]
  • The retropubic passage carries the same bladder-perforation risk seen with retropubic female MUS — and rare bowel injury.[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. Traction threads passed retropubically using needles from perineum to suprapubic region.
  4. Varitensor implanted subcutaneously over the rectus fascia ~ 2 cm above the pubis.
  5. Intraoperative regulation — sling tension adjusted with the external manipulator while performing a cough stress test or filling cystometry to achieve continence without obstruction.
  6. Cystoscopy to rule out bladder perforation from retropubic needle passage.

Postoperative readjustment is performed under local anesthesia by accessing the varitensor percutaneously with the external manipulator. This can be done at any time — early postoperatively or months to years later.[2]

Outcomes​

StudyNFollow-upOutcome
Sousa-Escandón 2004 (pilot)[1]618 mo83% continent; all satisfied
Sousa-Escandón 2007 (European MC)[2]5132 mo64.7% cured / 19.6% improved (84.3% combined); 86% required ≥ 1 readjustment 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 mo89.4% objective effectiveness across all severity strata (mild 85.7% / moderate 90.9% / severe 88.9%); 34% needed readjustment; device survival 95.7%
Chiu 2022[3]18—61.1% success; 2 / 18 (11.1%) bowel injury during retropubic passage
Altan 2017[6]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% — significantly worse than ATOMS on every endpoint

REMEEX vs ATOMS — head-to-head meta​

The Angulo 2021 SR/meta is the definitive comparison:[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 vs Remeex System II).

Complications​

  • Intraoperative bladder perforation 9.8% (Sousa-Escandón 2007 EMC) — analogous to retropubic female MUS; usually managed conservatively.[2]
  • Bowel injury — 11.1% in Chiu 2022 (2/18) during retropubic needle passage; rare but serious.[3]
  • Urethral erosion ~ 2%; varitensor infection ~ 4% requiring removal; perineal hematoma 5.9%.[2]
  • Pooled explantation 13.9% — meaningfully higher than ATOMS (5.5%, p = 0.027).[7]

Predictors of failure​

  • Prior pelvic radiotherapy — Kim 2016 OR 8.4 for failure, among the highest reported for any male sling.[4]
  • Higher baseline severity — OR 1.41 per pad (Kim 2016).[4]
  • Severity-related complete-dry gradient — non-severe 57.9% vs severe 23.1% (Altan 2017, p = 0.029) despite comparable overall success.[6]

Salvage​

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

Current positioning​

Remeex occupies a niche role today. Its conceptual advantage — the only truly non-invasive percutaneous re-tensioning mechanism — is offset by retropubic-passage risks (bladder / bowel injury) absent from transobturator devices, lower dryness rates, and higher explantation than ATOMS. May be considered in settings where ATOMS is unavailable.[7]

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