Dr. Ulhas Pote

Transobturator Tape (TOT)

Description
Faq's

What is Transobturator tape?

tape (TVT). The purpose of TOT and TVT is to treat the condition with which you have been diagnosed, namely, stress urinary incontinence (SUI).The way the tape is inserted and fitted is different in TOT.

It is felt that this makes TOT safer due to there being less chance of injury to your bladder, bowel or blood vessels as the tape is inserted. TOT is a form of keyhole surgery which means that the operation can be performed as a day case procedure and usually is associated with a quick recovery. On average the operation lasts about 30 minutes from the start of the anaesthetic until the time you wake up.

In both operations, TOT and TVT, a nylon mesh tape is placed underneath the urethra (the tube which allows urine to empty from your bladder). The tape will act like a hammock to support the urethra. The body makes scar tissue that grows into the mesh of the tape so helping it to stay in place. This scar tissue together with the tape give additional support to the urethra, making it less likely that you will leak urine. In TOT the tape is passed sideways through a natural space in your hip bone called the obturator foramen (window). The ends of the tape are brought to the surface through two tiny cuts just to the side of the lips of the vagina close to the groin creases.

What are the alternatives?

The treatment of stress urinary incontinence can be non-surgical in which you are taught to retrain your pelvic floor muscles by a physiotherapist. Otherwise the mainstay of treatment relies on surgery. Tape operations have taken over from the traditional abdominal operation.

What are the potential risks and side effects?

The main side effect of TOT is finding it hard to pass urine afterwards. This affects about 1 in 20 women. This may result in the need to have a temporary urethral catheter to allow the bladder to empty until it recovers. A small proportion of women may have a more serious degree of difficulty in emptying. We call this a ‘voiding’ difficulty. In this group of women it may be.

necessary to release the tape by cutting it or to teach the woman to empty her bladder with a small catheter every time she wishes to pass urine (intermittent self catheterisation). This is rare. Another less common problem is that the tape may become exposed within the vagina or within the bladder. We call this tape erosion. It occurs in about 1 in 50 women who have the procedure. This can usually be dealt with easily.

What is a TVT operation?

TVT Sling is an operation to treat stress urinary incontinence. Stress incontinence is leakage of urine that occurs with activities which cause an increase in abdominal pressure such as coughing, sneezing, jumping, lifting, exercising and in some cases walking.

What is TVT mesh?

In TVT surgery, a mesh tape is placed under your urethra like a sling or hammock to keep it in its normal position. The tape is inserted through tiny incisions in your abdomen and vaginal wall.

What is a TOT operation?

Transobturator tape (or TOT for short) is similar to an operation called Tension-free Vaginal tape (TVT). The purpose of TOT and TVT is to treat the condition with which you have been diagnosed, namely, stress urinary incontinence (SUI).The way the tape is inserted and fitted is different in TOT.

What is transobturator tape used for?

Stress urinary incontinence (SUI) can significantly impair the quality of life. A variety of treatments, both medical and surgical, have been used to manage it. The transobturator sling, which is a subfascial sling, is relatively a new surgical technique with minimal access.

How long should I bleed after TVT surgery?

Recovery after a TVT usually takes 1 to 4 weeks. Most patients take 2-4 weeks off work. Driving and other activities You should be able to drive and be fit enough for your usual activities within 1-2 weeks of surgery.

What is the procedure in TVT O?

The first operation in Singapore was performed at our hospital in November 1998. A newer version of the procedure, TVT-O (tension-free vaginal tape-obturator) was introduced in May 2004 in our hospital. It is equally good in curing stress urinary incontinence.

What is a bladder sling?

A bladder sling is used to treat stress urinary incontinence (SUI) in women. A bladder sling is made of strips of surgical mesh and is usually inserted through one vaginal incision and two small abdominal incisions.

What is a transobturator tape procedure?

This is a narrow strip of synthetic material placed in your body to support the urethra. The 'Monarc subfascial hammock' is a brand name for such a tape made by a company called American Medical Systems (AMS). The hammock cradles your urethra and gives it a solid point to rest on and press against.