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376 - IS REMEEX® SYSTEM SAFE AND EFFECTIVE IN OLD STRESS URINARY INCONTINENCE PATIENTS?

376

IS REMEEX®SYSTEM SAFE AND EFFECTIVE IN OLD STRESS URINARY INCONTINENCEPATIENTS?

H. LEE1, J. HAN 2,C. KIM 3, K. CHO 4, J. SEO 1;
1Urology, Cheil Gen. Hosp. & Women's Hlth.careCtr., Dankook Univ. Coll. of Med., Seoul, Korea, Republic of, 2PusanNatl. Univ. Yangsan Hosp., Yangsan, Korea, Republic of, 3GachonUniv. Gil Med. Ctr., Incheon, Korea, Republic of, 4Urology,The Catholic Univ. of Korea, Bucheon, Korea, Republic of.

Introduction: In patients withintrinsic sphincter deficiency (ISD) and recurrent stress urinaryincontinence (SUI) after previous anti-incontinence surgery, thereare concerns about the results of mid-urethral synthetic sling (MUS)operations. For these patients, the REMEEX® system (apost-operative adjustable midurethral sling system) could be anappropriate solution. However, the REMEEX® systemrequires an additional lower abdominal incision, which might bedifficult in older patients.
Objective: The aim of thisstudy was to evaluate the post-operative results of the REMEEX systemin old (≥65 years old) compared to young patients.
Methods:Fifty-eight patients with SUI due to ISD and previous MUS underwentREMEEX® system positioning between Jan. and Dec. 2013.Before surgery, patients were evaluated based on physicalexamination, urodynamics and parity. Post-operatively, voidingpattern, urine leakage and voiding uroflowmetry with post-voidingresidual urine were checked.
Results: The old age groupincluded 33 patients (70.6±4.6 years old), and the young age group(53.3±7.3 years old) included 25 patients. Baseline characteristicsare shown in Table 1. There were no patients with incontinence 1 weekafter operation; however, there were 2 patients with persistentincontinence 3 months after the operation (1 in the old age and 1 inthe young age group). There were significant differences in voidingpattern after the operation. In the old age group, 5 patientsunderwent clean intermittent catheterization because of voidingdifficulty. However, only 1 patient underwent clean intermittentcatheterization within 3 months (Table 2). Six patients underwentreadjustment of tension (5 in the old age and 1 in the young agegroup). After readjustment, all patients were continent and did notexperience voiding difficulty. There were no post-operativecomplications in either group. Post-operative uroflowmetry parametersare shown in Table 3.
Conclusions: The REMEEX®system is an effective procedure for ISD and recurrent SUI in bothold and young patients. In cases of ISD and recurrent SUI in olderpatients, the REMEEX system should be considered forcorrection.
References:

Table1. Baseline characteristics of the two groups

Parameter

Oldage (n=33)

Youngage (n=25)

Pvalue

Age(years)

70.6±4.6

53.3±7.3

<0.001

Parity(times)

2.7±1.2

2.0±0.8

0.029

MCC(mL)

356.9±69.4

394.5±62.2

0.018

Qmax(mL/min)

16.6±6.7

24.4±6.9

<0.001

VLPP(cmH2O)

54.6±14.2

56.4±11.5

0.592

UFMvolume (mL)

237.5±94.5

266.7±98.3

0.12

UFMQmax(mL/min)

9.9±4.8

13.9±5.6

0.015

UFMPVR (mL)

5.8±15.5

1.2±6.0

0.167

Stameygrade

1

22(66.7%)

11(44.0%)

0.072

2

11(33.3%)

14(56.0%)



Table2. Post-operative voiding pattern


Oldage (n=33)

Youngage (n=25)

Pvalue

Normal

22(66.7%)

15(60.0%)

0.042

Straining

6(18.2%)

10(40.0%)

CIC

5(15.1%)

0



Table3. Post-operative uroflowmetry parameters of two groups

Post-operativetiming

Parameters

Oldage (n=33)

Youngage (n=25)

Pvalue

Immediately

Voidingvolume (mL)

185.9±81

264.6±140.8

0.009

Qmax(mL/min)

12.4±5.1

16.1±7.3

0.187

PVR(mL)

4.4±2.2

6.3±3.5

0.962

1month postoperative

Voidingvolume (mL)

237.9±166.7

281.9±201.8

0.373

Qmax(mL/min)

15.8±8.8

18.8±11.9

0.112

PVR(mL)

39.4±58.0

16.6±33.6

0.006

3months postoperative

Voidingvolume (mL)

185.0±149.4

161.6±184.1

0.125

Qmax(mL/min)

12.2±9.3

11.9±12.6

0.008

PVR(mL)

30.7±65.7

16.8±52.5

0.231