TOT (Transobturator Tape) in Turkey

Transobturator Tape, often abbreviated as TOT, is a surgical procedure and medical device used in the treatment of stress urinary incontinence (SUI) in women. Stress urinary incontinence is a condition in which the patient experiences involuntary leakage of urine during activities that increase intra-abdominal pressure, such as coughing, sneezing, laughing, or exercising. TOT is one of the surgical approaches used to address this issue.

The TOT procedure involves the placement of a synthetic tape or mesh sling underneath the urethra to support and stabilize it. This tape is inserted through small incisions made in the vaginal wall and exited through incisions made in the upper thigh area (the transobturator space). The tape acts as a hammock or sling, providing extra support to the urethra and preventing unintentional urine leakage when pressure is exerted on the bladder.

TOT Methods

Inside-Out TOT (TVT-O or TOT):

- The "inside-out" or TVT-O (Tension-free Vaginal Tape Obturator) method is one of the common approaches for performing a TOT procedure.

- The surgeon makes small incisions in the vaginal wall, near the urethra.

- A synthetic mesh tape is passed through these incisions under the urethra, and then the ends of the tape are passed through the obturator foramen, which is a bony structure in the groin area.

- By positioning the tape in this manner, it provides support to the urethra and prevents urine leakage when there is increased intra-abdominal pressure.

Outside-In TOT:

- The "outside-in" TOT method is less common than the inside-out method.

- In this technique, small incisions are made in the groin area first, and then the synthetic mesh tape is guided from the outside to the inside, passing through the obturator foramen and under the urethra.

- The tape is then anchored in place to provide support to the urethra.

Adjusted TOT Techniques:

- In addition to the standard TVT-O and outside-in TOT methods, there are variations and adjusted techniques to tailor the procedure to the specific needs of the patient.

- Some surgeons may make modifications based on the patient's anatomy or the severity of the SUI.

- For example, some variations involve using different types of mesh materials or adjusting in the tape placement.

It's important to note that the specific method used may vary depending on the surgeon's experience and training, as well as the patient's individual circumstances. The choice of technique should be discussed with a healthcare provider who will consider the patient's condition and anatomy to determine the most appropriate approach.

How does TOT Tape work?

Placement of the Mesh Tape: During a TOT procedure, a synthetic mesh tape or sling is inserted through small incisions made in the vaginal wall and passed underneath the urethra. The tape is positioned in a way that supports the urethra from below.

Support for the Urethra: The mesh tape acts like a hammock or sling, providing a supportive platform for the urethra. This support helps to stabilize the urethra and prevents it from moving excessively during physical activities that can trigger SUI, such as coughing, sneezing, laughing, or exercising.

Improved Continence: By supporting the urethra, the TOT tape helps maintain proper closure of the urethral sphincter muscles. When intra-abdominal pressure increases, as in the cases mentioned above, the tape offers resistance against the downward movement of the urethra, preventing unintentional urine leakage.

Restored Urinary Control: The net effect of the TOT procedure is improved urinary control. Patients who undergo TOT surgery typically experience a reduction or elimination of stress urinary incontinence symptoms, allowing them to engage in normal daily activities without the fear of involuntary urine leakage.

Before TOT Surgery

Before undergoing Transobturator Tape (TOT) surgery, it is essential for patients to have a comprehensive evaluation and thorough discussion with their healthcare provider. This initial phase involves a detailed assessment of the patient's medical history, the severity of their stress urinary incontinence (SUI), and their overall health. It is crucial for the healthcare provider to explain the surgical procedure, potential risks, benefits, and expected outcomes.

Patients should also be informed of alternative treatment options available for SUI. Consent for the surgery will be obtained after ensuring that the patient understands the procedure, its implications, and possible complications. In some cases, additional tests or evaluations may be necessary to assess the patient's condition fully. This pre-surgery consultation provides an opportunity for patients to ask questions, clarify doubts, and make informed decisions regarding their SUI treatment. It is essential for patients to follow preoperative instructions carefully, which may include dietary restrictions, medication adjustments, and other preparatory measures to ensure a successful surgical experience and optimal recovery.

After TOT Surgery

Following Transobturator Tape (TOT) surgery for the treatment of stress urinary incontinence (SUI), patients will enter the post-operative phase, which requires a period of recovery and care. It's crucial for patients to adhere to the specific instructions provided by their surgeon and medical team. Typically, patients will experience some discomfort and swelling in the days immediately following the procedure, which can be managed with prescribed pain medication. While the recovery time for TOT surgery is generally shorter than other surgical methods for SUI, it is essential to take it easy and avoid strenuous activities during the initial weeks. Patients should also follow any guidelines regarding hygiene and incision care to prevent infection. In most cases, patients will have a follow-up appointment with their surgeon to assess the healing progress and discuss any concerns or questions.

While the success rate of TOT surgery in reducing or eliminating SUI symptoms is generally high, patients should be aware of potential complications, such as infection, urinary retention, or mesh-related issues, and promptly report any unusual symptoms to their healthcare provider. With proper post-operative care and adherence to medical advice, patients can look forward to improved urinary control and a better quality of life following TOT surgery.