About Trans Obturator Tape (TOT)

Transobturator Tape (TOT) is a minimally invasive surgical procedure used to treat stress urinary incontinence (SUI) in women. This condition occurs when there is involuntary leakage of urine during activities that increase abdominal pressure, such as coughing, sneezing, laughing, or exercising.

The TOT procedure involves placing a synthetic mesh tape under the urethra to provide support, helping to prevent urine leakage. The tape is inserted through small incisions in the vaginal and thigh areas, passing through the obturator foramen (a hole in the pelvic bone), hence the name "transobturator."

Transobturator Tape (TOT) Procedure

TOT procedure involves minimally invasive surgery for women suffering from stress urinary incontinence due to various physical factors suddenly. Physical activities like coughing or exerting oneself vigorously somehow put pressure on bladder muscles causing involuntary urine leakage suddenly. The TOT procedure involves placing a synthetic mesh tape under the mid-portion of the urethra to provide support and prevent involuntary leakage.

Procedure Overview

• Preparation: The patient is positioned in a dorsal lithotomy position, and local anesthesia is administered. A Foley catheter may be inserted for urinary drainage during the procedure.
• Incision: A small incision (approximately 2 cm) is made in the vaginal wall over the urethra.
• Tape Placement: Using specialized instruments, a trocar is inserted through the vaginal incision and directed towards the obturator foramen, creating a tunnel for the tape. The tape is then passed through this tunnel and positioned under the mid-urethra without tension.
• Securing the Tape: The ends of the tape are brought out through small incisions in the groin area and cut just beneath the skin. The tension of the tape is carefully adjusted to ensure proper support without causing urethral obstruction.
• Closure: The vaginal incision is sutured, and any additional incisions are closed using absorbable sutures or steri-strips.

Preoperative Considerations

• Urodynamic Testing: Prior to surgery, patients typically undergo urodynamic studies to confirm the diagnosis of stress urinary incontinence and assess bladder function.
• Medical History Review: A thorough review of the patient's medical history and any previous surgeries is conducted to identify potential risks.
• Informed Consent: Patients are informed about the procedure, potential risks, and expected outcomes, allowing them to make an educated decision.

Postoperative Care

• Monitoring: Patients are observed for any immediate complications following surgery, such as bleeding or infection.
• Pain Management: Mild pain or discomfort can be managed with over-the-counter pain relievers as needed.
• Activity Restrictions: Patients are advised to avoid heavy lifting or strenuous activities for a few weeks post-surgery to facilitate healing.
• Follow-Up Appointments: Regular follow-up visits are scheduled to monitor recovery and assess the effectiveness of the procedure.

Recovery After Transobturator Tape (TOT) Surgery

Most patients can return home on the same day as the surgery. Full recovery typically takes about 4 to 6 weeks, during which patients may gradually resume normal activities. Many experience significant improvement in urinary control shortly after surgery, with long-term success rates being favorable.

Advantages of Transobturator Tape (TOT)

1. Minimally Invasive

The TOT procedure avoids the retropubic space, reducing the risk of injury to vital structures like the bladder, blood vessels, and bowels. This approach ensures safer outcomes compared to traditional methods like Tension-Free Vaginal Tape (TVT).

2. Shorter Operating Time

Studies have shown that TOT has a significantly shorter operating time compared to TVT, which enhances efficiency and reduces patient discomfort during surgery.

3. Lower Risk of Complications

By bypassing the retropubic space, TOT minimizes complications such as bladder perforation, vascular injuries, and bowel damage. Additionally, it has lower rates of mesh erosion and dyspareunia (painful intercourse).

4. High Success Rates

TOT demonstrates excellent short- and medium-term success rates in curing or improving SUI symptoms. Studies report cure rates of up to 92% after 12 months and 85% after 24 months.

5. Faster Recovery

Patients experience quicker recovery times due to the minimally invasive nature of the procedure, allowing them to return to normal activities sooner.

6. Improved Quality of Life

TOT significantly enhances patients' quality of life by effectively addressing urinary leakage, as evidenced by improvements in satisfaction scales and reduced pad usage.

7. Cost-Effective

Surgeon-tailored TOT meshes have been found to be cost-effective while maintaining comparable outcomes to traditional meshes, making it accessible for more patients.