Trans-Obturator Tape (TOT)

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What is Trans-Obturator Tape?

Trans-Obturator Tape (TOT) procedure is designed to provide support for a sagging urethra so that when you cough or move vigorously or suddenly the urethra can remain closed with no accidental release of urine.

When is it used?

This procedure is used to correct stress incontinence caused by sagging of the urethra. It is a relatively simple procedure that can be done with minimal hospitalization and recovery time. In addition, TOT has been shown to be effective in relieving stress incontinence in women who are obese and have increased pressure on the bladder and urethra.

What are the benefits of this procedure?

TOT surgery can be an effective and relatively noninvasive treatment for stress incontinence. A recent study reported a cure rate between 85% and 87%, with an additional 4.5% to 7% of participants reporting improvement in symptoms.

TOT appears to be a safe and effective treatment for obese women with stress incontinence.

What are the risks associated with this procedure?

  • Damage to a vein or artery that could cause serious bleeding.
  • Making a hole in the bladder could cause a tract (fistula) between the vagina and bladder.
  • That urine leakage may not be improved.
  • That a bulging bladder (cystocele) may not improve or could return.
  • Damage to the ureters, the tubes that carry urine from the kidneys to the bladder.
  • Damage to the small intestines or colon.
  • You may have difficulty emptying my bladder.
  • You may develop bulging in my rectum (rectocele) or my vagina (vaginal vault eversion).
  • You may develop infection in my incision, the area around my bladder, or my bladder

How do I prepare for the procedure?

Follow your health care provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after surgery.

Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before midnight.  After midnight you should not eat or drink coffee, tea, or water. Your physician may also recommend bowel prep.

What happens after the procedure?

Usually within hours of your surgery, you will be asked to urinate to test the response of your bladder and urethra to the surgery. You may be released to go home the same day as your surgery, or you may remain in the hospital overnight. It may be necessary to have a thin, flexible tube (catheter) placed into your bladder through your urethra to allow urine to drain while you recover or to teach you to perform self-catheterization temporarily. 

TOT surgery usually causes minimal pain and discomfort. Although you may resume most normal activities within 1 to 2 weeks, you will be advised to refrain from driving for 2 weeks and from sexual intercourse or strenuous activities for 6 weeks.

When should I call Greenville OB/GYN

Call our emergency number at any time if:

  • You have a fever over 100 F (37.8 C).

Call during regular office hours if:

  • You have questions about the procedure or its result.
  • You want to make another appointment.

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