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Transobturator tape (TOT)
Transobturator tape (TOT) is an effective surgical method of treating SUI which occurs mostly in women. SUI is characterized by leakage of urine, when a person’s physical activity compels him or her to cough, sneeze, or perform any other exercise, because of weak pelvic floor muscles or weakened support of the urethra.
Procedure Overview
Objective
The objective of performing the TOT procedure is to support the urethra by inserting a synthetic tape underneath.
Method
The tape is introduced within the biphasic trans-obturator procedure through minimum incision sites in the groin, through the obturator foramen and under the mid-urethra.
Advantages
Elimination of starvation before the surgery and large abdominal incision prevents repositioning of the surrounding tissues thereby reducing the “bars” and also making it less than the retropubic approach.
Symptoms Of Transobturator Tape
The main complaint treated by the trans obturator tape is urinary incontinence due to exertion. Women suffering from such incontinence usually observe these features: Also, involuntary loss of urine while engaging in stress-upsetting activities especially when physical stress is, either voluntary or involuntary, has been covering the abdomen, sneezing, or laughing or playing or doing weight lifting, etc.
The feeling of the need to urinate often when there is very little urine in the bladder.
Involuntary urination which occurs during daily activities causes a feeling of uneasiness and results in restriction of normal functioning.
Transobturator Tape Treatment
Initial Consultation
The first step is seen when a urologist or gynaecologist examines a patient. This is useful to determine the degree of incontinence and assess previous medical treatment.
There is a possibility of further diagnostic testing such as urodynamics or pelvic ultrasound to support the diagnosis.
The TOT Procedure
Anesthesia: Most commonly, surgery of this type is done with local, regional or general anaesthesia.
Incisions: Little incisions are made over the groin area to introduce the tape through the obturator foramen.
Placement: Mid-urethral synthetic tape is inserted surgically for support at the centre and appears like one that helps lift a woman’s bladder.
Postoperative Care
Most of the patients after the procedure of TOT are discharged the same day as the process with an improvement in the symptoms.
Most of the patients are advised to refrain from heavy lifting, rigorous activities and sexual intercourse for a couple of weeks.
Other follow-up assessments will be done to check the recovery and if the tape is working well.
Benefits
There is a greater rate of relieve or cure of stress urinary incontinence.
There is a longer minimal invasive procedure with a shorter duration of recovery in comparison to other alternatives available. There is a low likelihood of complications like injury to the bladder.
Risks and Complications
Likely issues that may arise include mesh-related issues such as erosion/infection. Groin or thigh pain is a common symptom. In some cases, urinary retention or difficulties in urinating may be experienced. Occasional cases of persistent incontinence or other urinary symptoms may be encountered.
As TOT has been thought as the last option when conservative treatment such as pelvic floor muscle exercise fails TOT is also effective in the treatment of stress urinary incontinence which is a problem for so many women.