TOT (Transobturator Tape) Surgery: Expert Care for Stress Incontinence

TOT surgery is a minimally invasive procedure where a supportive tape is placed to treat stress urinary incontinence by supporting the urethra.

• Effective for women with stress urinary incontinence (SUI)
• Tape is inserted through small groin incisions
• Supports the mid-urethra to prevent urine leakage during pressure

Women with moderate-to-severe stress urinary incontinence who haven’t improved with pelvic floor therapy may be good candidates for TOT surgery.

• Symptoms like urine leakage when coughing, sneezing, or exercising
• Failed conservative treatment (e.g., Kegels, medications)
• Not pregnant and in good general health

TOT offers high success rates, fewer complications, minimal downtime, and long-term relief for stress urinary incontinence in properly selected patients.

• Less risk of bladder or bowel injury compared to TVT
• Day-care procedure with short recovery time
• Does not require abdominal incisions

Before TOT surgery, patients are advised to stop blood thinners, fast for 6 hours, and undergo urine tests and anesthesia clearance.

• Preoperative urinalysis to rule out infections
• Fasting for 6–8 hours before surgery
• Discontinue blood thinners or anti-inflammatory drugs if advised
• Complete anesthesia risk assessment and consent forms

TOT involves placing a synthetic tape under the urethra via small groin incisions under anesthesia, typically completed in under 30 minutes.

• Local, spinal, or general anesthesia may be used
• Small incisions near the inner thighs
• Mesh tape inserted to cradle the urethra for support
• No abdominal cuts or stitches needed

After TOT surgery, patients must follow hygiene precautions, avoid heavy lifting, and attend follow-up visits to monitor healing and bladder function.

• Resume light activities within 2–3 days
• Avoid intercourse and strenuous workouts for 4–6 weeks
• Watch for signs of infection like fever or pain
• Maintain good genital hygiene during recovery

Although rare, complications of TOT may include mesh erosion, infection, groin pain, or difficulty in urination that may require medical attention.

• Mesh exposure or vaginal erosion
• Groin or thigh pain post-surgery
• Urinary retention or incomplete bladder emptying
• Infections or hematoma at the incision site

Most women resume desk work in 2–3 days and normal physical activity within 4–6 weeks post-TOT, with gradual return based on surgeon advice.

• Office work: 2–5 days
• Light walking: within 48 hours
• Heavy lifting, intercourse: after 4–6 weeks

TOT surgery has long-term success rates of over 85%, especially when combined with weight management and pelvic muscle strengthening.

• Most women report significantly reduced or eliminated leakage
• Durability lasts several years with proper follow-up
• Few require repeat procedures if lifestyle advice is followed

ICD-10 Codes Related to TOT (Transobturator Tape) Procedure

CPT Codes for TOT (Transobturator Tape) Surgery

Q1. What is a transobturator tape?

Ans. A transobturator tape (TOT) is a synthetic mesh used in minimally invasive surgery to support the mid-urethra and treat stress urinary incontinence in women.

Q2. What is the difference between TOT and TVT?

Ans. TOT passes through the obturator foramen (side of the thigh), while TVT (tension-free vaginal tape) passes through the retropubic space. TOT has a lower risk of bladder injury.

Q3. Is transobturator tape the same as mesh?

Ans. TOT is a type of surgical mesh designed specifically for mid-urethral support. Not all mesh procedures are TOT.

Q4. What is the purpose of TOT surgery?

Ans. The main purpose of TOT surgery is to provide support to the urethra and prevent involuntary urine leakage during activities like coughing, sneezing, or exercising.

Q5. What is the success rate of transobturator sling?

Ans. Success rates range from 80% to 90%, depending on the patient’s health, severity of incontinence, and surgeon experience.

Q6. What are the side effects of TOT surgery?

Ans. Side effects may include groin pain, difficulty urinating, infection, or mesh erosion in rare cases.

Q7. Can TOT tape be removed?

Ans. Yes, TOT tape can be removed partially or completely if complications arise, although removal may be complex.

Q8. How painful is bladder sling surgery?

Ans. Pain is generally mild to moderate and resolves within days to weeks with pain medication and rest.

Q9. How long do you bleed after TOT surgery?

Ans. Light spotting or discharge is common for up to 1–2 weeks post-surgery. Heavy or persistent bleeding should be evaluated by a doctor.

Q10. What is the gold standard surgery for stress incontinence?

Ans. Mid-urethral sling surgery, including TOT and TVT, is widely considered the gold standard treatment for stress urinary incontinence.

Q11. What does TOT mean in surgery?

Ans. TOT stands for “Transobturator Tape,” a minimally invasive mesh-based sling placed through the groin to support the urethra.

Q12. Where does a transobturator sling go?

Ans. It is placed under the urethra and passed through the obturator foramen in the inner thigh to create a hammock-like support.

Q13. When should surgical tape be removed?

Ans. TOT tape is permanent unless complications occur. Removal is considered only if the patient experiences persistent pain, erosion, or infection.

Q14. Which is better, TVT or TOT?

Ans. TOT has fewer complications related to bladder and bowel injuries, while TVT may be more effective in severe cases. The best choice depends on patient anatomy and surgeon recommendation.

Q15. What is the price of transobturator tape surgery?

Ans. In India, the cost can range from ₹45,000 to ₹1,20,000, depending on hospital, surgeon expertise, and the type of mesh used.