Best Treatment for TOT (Transobturator Tape) for Stress Urinary Incontinence
TOT or trans obturator tape procedure is done to relieve the stress urinary incontinence. The success rate of TOT procedure is 82 to 96%. TOT is aimed to give you more control over your bladder and prevent urinary leakage whenever the pressure inside your belly increases like coughing, or laughing out loud.
- You will be asked to do urodynamic studies first to confirm the diagnosis of stress incontinence.
- You will be asked to carry out all routine blood investigations reports; like hemogram; liver and kidney function tests; x-ray chest; ECG; sonography etc.
- You will be asked to stop medicines like hormonal pills and aspirin and will be advised to continue your thyroid; blood pressure or diabetes medicines.
- You will be called on the day of surgery to fast.
TOT procedure is done under spinal or general anesthesia.
A small incision is placed on the vaginal wall and the permanent trans obturator tape is introduced through the vagina this sits under the urethra with the help of specially designed needles that come out through the upper thigh.
The tape inserted this way will push up the urethra which has come down due to aging or repeated vaginal childbirths. Once the urethra goes back to its normal position; there is no direct pressure transmission from the bladder to the urethra. This prevents urine leakages.
This TOT tape is a permanent mesh and does not get dissolved in the body. The effect of TOT lasts lifelong.
Postoperative Care and Discharge;
- You will be in the recovery room for 1 or 2 hours the monitoring your vitals like a pulse; BP; oxygen level and bleeding.
- You will be asked to start having clear liquids after 2 hours followed by light diet.
- You will be asked to walk around after 3 to 4 hours. If you do not have a catheter, you will be encouraged to go to the washroom to pass urine
- If you have a catheter in the bladder (to drain the urine) and you may have a vaginal pack (dressing) in your vagina and it will be removed 24 hours after the surgery. And you will be discharged the next day.
- If other surgery like vaginal repair has been performed at the same time, the catheter may be kept in for a few more days and you may have to be in hospital for 3 – 4 days.
- The cut on your thigh is usually sealed by inner absorbable stitching which does not require any removal.
- Your recovery should be fairly quick and you will be able to return to light activities after 1 – 2 weeks.
- You may experience mild vaginal bleeding or discharge which will subside on its own in 3 to 4 days. In case of persistent problems; you have to inform your gynecologist.
- You will be asked to avoid sexual intercourse; heavy weight lifting; constipation; smoking and weight gain for 4 to 6 weeks to prevent complications
Complications of Tot Procedure
Serious complications are rare with TOT procedure. However, no surgery is without risks and the potential complications are:
- Bladder irritability like urgency and overactive bladder.
- Injury to the surrounding structures.
- Retention of urine; or inability to pass urine.
- The tape eroding into the surrounding organs.
Pain in groin or thigh associated with tape.