Stress Incontinence - Transobturator Tape (TOT)

You are losing urine when coughing or laughing, sneezing or lifting?

A small procedure provides lasting success!

In women with stress urinary incontinence (SUI), the closure of the urethra is weakened. It opens involuntarily when pressure increases in the abdominal cavity through sneezing, coughing or physical exertion, so that urine passes to the outside. If, however, the urethra is supported and preventing from lowering, the sphincter does not open immediately when pressure on the bladder is experienced. The insertion of a urethral transobturator tape (TOT) acts as a support. An artifical tape is placed loosely under the urethra, so that it does not immediately yield under pressure. The band also stimulates the cells to produce connective tissue. This a great advantage since weak tissue is a major cause of stress incontinence.

The surgical technique is relatively simple. Under a short anesthesia, a small incision is made at the anterior vaginal wall. The tape is then placed underneath the urethra through this opening. The band is not sutured, and - like in earlier surgical methods (TVT) – lies tension-free under the midurethra. The results of many studies show that compared to the older TVT surgeries there is the same long-term effect while the complication rates are much lower. The success rate is 93% (90% healing, 3% improvement). Complications are minor and mainly concern an initial voiding dysfunction due to over-correction.

The classic and widely accepted indication for placing a TOT tape is pure stress incontinence and, in selected cases, the so-called mixed incontinence. The process can be successfully performed as a primary or recurrence surgery. The procedure can be performed in ambulatory care or during a short hospital stay.