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Treatment for TOT (Transobturator Tape)

Home » Treatment for TOT (Transobturator Tape)

Treatment for TOT  or transobturator tape procedure is done to relieve the stress urinary incontinence. The success rate of TOT procedure is 82 to 96%.  Treatment for TOT  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.

 

ICD-10 Codes for Treatment of TOT (Transobturator Tape) Procedure:

The TOT procedure is a type of surgical treatment for stress urinary incontinence. The ICD-10 code relevant to the diagnosis of stress urinary incontinence is:

  • N39.3: Stress incontinence (female)

CPT Codes for TOT Procedure:

The TOT procedure involves placing a tape or mesh to support the urethra. Relevant CPT codes for the TOT procedure include:

  • 57288: Insertion of mid-urethral sling (TOT or similar procedure)
  • 57287: Insertion of mid-urethral sling (includes both TOT and other similar procedures)

These codes cover the surgical insertion of a mid-urethral sling, which includes the TOT procedure as well as similar techniques. The choice of CPT code will depend on the specifics of the surgical approach used.

Dr. Dimple Doshi at Vardaan Hospital; believes prevention is better than cure, and thus apart from the precise treatment guidelines; preventive measures are an essential part of our consultations with the patients who have either had it or want to know more about it.

  1. You will be asked to do urodynamic studies first to confirm the diagnosis of stress incontinence.
  2. 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.
  3. 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.
  4. 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.

  1. You will be in the recovery room for 1 or 2 hours the monitoring your vitals like a pulse; BP; oxygen level and bleeding.
  2. You will be asked to start having clear liquids after 2 hours followed by light diet.
  3. 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
  4. 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.
  5. 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.
  6. The cut on your thigh is usually sealed by inner absorbable stitching which does not require any removal.
  7. Your recovery should be fairly quick and you will be able to return to light activities after 1 – 2 weeks.
  8. 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.
  9. You will be asked to avoid sexual intercourse; heavy weight lifting; constipation; smoking and weight gain for 4 to 6 weeks to prevent complications

Serious complications are rare with TOT procedure. However, no surgery is without risks and the potential complications are:

  1. Bladder irritability like urgency and overactive bladder.
  2. infection
  3. Bleeding
  4. Injury to the surrounding structures.
  5. Retention of urine; or inability to pass urine.
  6. The tape eroding into the surrounding organs.

Pain in groin or thigh associated with tape.

Symptoms of adnexal mass may be different for different people depending upon its cause.

Common symptoms are:

  1. Severe lower abdominal or pelvic pain that is sometime only on one side
  2. Abnormal bleeding pattern; including heavy nf prolonged periods.
  3. Feeling of fullness, bloating, constipation, indigestion, nausea, vomiting
  4. Urinary symptoms
  5. Fatigue
  6. Fever
  7. Vaginal discharge

Conservative treatment:

If the adnexal mass is small and you have no symptoms, then it may not require treatment at all. However, your gynecologist will monitor you with regular pelvic exams and ultrasounds.

Surgery will be needed if:

  • The mass begins to grow
  • You develop symptoms
  • A cyst develops solid elements or any finding that is suggestive of cancerous nature of the mass.

Laparocopy:

Laparoscopic removal of the adnexal mass is the ideal treatment.

The advantages of laparoscopy include speedy recovery, less pain and cosmetically better appearance.

Laparotomy:

Laparotomy or opening up of the abdomen is indicated if

1.         The adnexal mass is likely to be malignant

2.         The patient is not fit to undergo laparoscopy

3.         The adnexal mass is huge

Once removed, the adnexal mass will be sent to the lab to determine whether or not the cells contained within it are cancerous. If they are, further treatment may be required under the guidance of an onto physician.