Prosthetic Material Exposure After Remeex System Implantation for Female Stress Urinary Incontinence: A Retrospective Cohort Study

Abstract Background The Remeex system is a readjustable midurethral sling used for the management of complex or recurrent female stress urinary incontinence (SUI), particularly in patients with intrinsic sphincter deficiency. Although favorable functional outcomes have been reported, evidence regarding prosthetic material exposure and its associated factors remains limited. This study aimed to evaluate the frequency and factors associated with prosthetic material exposure after Remeex system implantation. Methods This retrospective cohort study included 76 women who underwent Remeex System implantation for SUI at a tertiary referral center in Mexico between 2018 and 2023. Clinical characteristics, previous surgical history, and preoperative factors were compared between patients with and without prosthetic material exposure. Quantitative variables were compared using the Mann-Whitney U test and categorical variables using Fisher’s exact test. Associations were expressed as odds ratios (Ors) with 95% confidence intervals (Cis). A p-value < 0.05 was considered statistically significant. Results Prosthetic material exposure occurred in 17 of 76 patients (22.4%). Among patients with exposure, 10/17 (58.8%) developed exposure within the first 12 months. Vaginal hysterectomy was associated with prosthetic material exposure (OR 7.92, 95% CI 1.46–46.21; p = 0.04), as was a contaminated preoperative urine culture (OR 13.62, 95% CI 1.81–178.7; p = 0.02). Other evaluated clinical characteristics were not significantly associated with exposure. Conservative management was the most frequently used treatment among patients with exposure. Conclusions Prosthetic material exposure occurred in approximately one-fifth of women undergoing Remeex system implantation in this cohort. Vaginal hysterectomy and a contaminated preoperative urine culture were associated with exposure, although the wide confidence intervals indicate uncertainty regarding the magnitude of these associations. These findings support further investigation of factors associated with prosthetic material exposure in larger cohorts.