The treatment of stress urinary incontinence (SUI) with synthetic mesh provides good outcomes; however, it may be associated with complications, particularly in patients with prior mesh extrusion or chronic pelvic pain, impacting quality of life. In this context, autologous grafts combined with adjustable systems represent a safe and effective alternative.
We aim to describe the surgical technique of an autologous rectus fascia sling using a tension-free vaginal tape (TVT)-like approach combined with an adjustable system (REEMEX), through a surgical video, and to evaluate its functional and sexual outcomes.

We present the case of a 48-year-old woman who underwent a transobturator sling for SUI in 2015 and required mesh excision in 2017 due to extrusion, subsequently developing chronic pelvic pain refractory to conservative treatment. In 2024, she presented recurrent SUI.

Cystoscopy was normal. Pelvic magnetic resonance imaging showed findings consistent with myofascial syndrome. Urodynamic evaluation confirmed SUI, with no evidence of bladder outlet obstruction or detrusor overactivity.

Surgery was performed under epidural anesthesia. An autologous rectus fascia graft was harvested through a suprapubic Pfannestiel incision and prepared with polypropylene sutures for connection to the REMEX system. Through a vaginal approach with anterior colpotomy and retropubic passage of the sutures, the graft was positioned at the mid-urethra and connected to the suprapubic adjuster. Intraoperative cystoscopy excluded bladder perforation, and a mild initial adjustment was performed.

The patient was discharged 24 hours postoperatively without the need for readjustment, with negligible post-void residual. At four-month follow-up, she reported no urinary leakage and a marked improvement in quality of life. Sexual function, assessed using the validated Spanish version of the PISQ-IR questionnaire, showed significant improvement. Uroflowmetry was normal (Qmax 16.7ml/s), with negligible post-void residual.

The combination of an autologous sling with an adjustable system allows restoration of a dynamic and physiological continence mechanism while avoiding synthetic material. It represents a safe and effective option in complex or recurrent SUI, with a positive impact on sexual function and quality of life.

Continence 19S (2026) 102523
DOI: 10.1016/j.cont.2026.102523