Transobturator Tape (TOT) in Management of Female Stress Urinary Incontinence


  • Ali Abdulbaqi Ali University of Thi-Qar,College of Medicine,Iraq
  • Harith Adel Jasim University of Thi-Qar,College of Medicine,Iraq
  • Abdulhadi Jabbar Sarhan University of Thi-Qar,College of Medicine,Iraq


BACKGROUND Transobtorator tape (TOT) is a minimally invasive procedure that gained increased popularity in the surgical field for management of patients with stress urinary incontinence . The use of TOT had significantly simplified the surgical procedure and made it safer.                  OBJECTIVES To evaluate the safety and efficacy of the TOT procedure in women with SUI PATIENTS AND METHOD Thirty female patient are complaining of urinary incontinence presented at urology department of Ghazi Al-Hariri surgical specialties hospital from January 2012-Oct. 2013 were enrolled in this study. All of our patients are with pure SUI. The procedure was done under spinal anesthesia. TOT require placement of macroporous polypropylene tape at the mid urethra through the obturator membrane with minimal vaginal incision. The patients were followed up before discharge, 1 month and six month using cough test.  RESULTS Mean patients age is 48.2 year (range 30-60 year) with a mean parity of 5(range from 3-7 child). The mean operating time is 26.5 minutes (ranging from 20-30 minutes). Intraoperative complications occur in 6 patients (20%), include hemorrhage in 5 patients, hematoma in one patient. The total incidence of postoperative complication was 36%, transient thigh pain occurred in seven patients, two patients got retention, two patients got de novo urgency. The objective cure rate was 93.3% CONCLUSION The TOT procedure is a safe and effective technique for the management of patient complaining of SUI.


Abrams P, Cardozo L, Fall M, et al; Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn 2002;21(2):167–78.

Annual Meeting of the International Continence Society, Paris 2004.

Tanagho Emil A. Urinary incontinence. Smith’s General Urology. ed. 18th.2012 pp. 435–491


Viktrup L: The risk of lower urinary tract symptoms five years after the first delivery. Neurourol Urodyn 21:2-29, 2002.

Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA 2008;300(111):1311–16.

Costa P, Grise P, et al: Surgical treatment of female stress urinary incontinence with trans obturator tape (T.O.T.®): Short term results of a prospective multicenter study. Eur Urol 46:102-106, Paris 2004.

Chapple CR, MacDiarmid SA, Patel A. Urodynamics made easy. 3rd ed. Oxford (UK): Churchill Livingstone Elsevier; 2009.

Chaliha C et al: Changes in urethral function with bladder filling in the presence of urodynamic stress incontinence and detrusor overactivity. Am J Obstet Gynecol 2005;192:60.

Milsom I, Abrams P, Cardozo L, et al. (2001) How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. Br J Urol Int 87(9)

Andersson KE, Chapple CR, Cardozo L, et al. Pharmacological treatment of overactive bladder: report from the International Consultation on Incontinence. Curr Opin Urol 2009;19:380–94.

Appell RA, Dmochowski RR, Herschorn S: Urethral injections for stress urinary incontinence. BJU Int 2006;98(suppl 1):27.

TerMeulen PH, Berghmans LC, Nieman FH, van Kerrebroeck PE. Effects of Macroplastique implantation system for stress urinary incontinence and urethral hypermobility in women. Int Urogynecol J Pelvic Floor Dysfunct. 2009;2:177–183.

Maher CF, O’Reilly BA, Dwyer PL, Carey MP, Cornish A, Schluter P. Pubovaginal sling versus transurethral Macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomised controlled trial. BJOG. 2005;112:797–801.

Hurtado E, McCrery R, Appell R. The safety and efficacy of ethylene vinyl alcohol copolymer as an intra-urethral bulking agent in women with intrinsic urethral deficiency.Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:869–873.

Bano F, Barrington JW, Dyer R. Comparison between porcine dermal implant (Permacol) and silicone injection (Macroplastique) for urodynamic stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:147–150.

Roumeguere T, Quackels T, Bollens R, et al. 2005. Trans-obturator vaginal tape (TOT) for female stress incontinence: One year follow-up in 120 patients. EurUrol 48:805 9.

Fischer A, Fink T, Zachmann S, Eickenbusch U. Comparison of retropubic and outside-in transobturator sling systems for the cure of female genuine stress urinary incontinence. Eur Urol 2005;48:799.

Morey AF, Medendorp AR, Noller MW, et al. 2006. Transobturator versus trans-abdominal mid urethral slings: A multi-Institutional comparison of obstructive voiding complications. J Urol 175:1014 ^17.

Spinosa JP, Dubuis PY. 2005. Suburethral sling inserted by the transobturator route in the treatment of female stress urinary incontinence: Preliminary results in 117 cases. EURO 5361:1^6.

De Tayrac R, Deffi eux X, Droupy S, et al: A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Am J Obstet Gynecol 190:602-608, 2004.

Delorme E: Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 11:1306-1313, 2001.

Delorme E, Droupy S, de Tayrac R, Delmas V: Tranobturator tape: A new minimally invasive procedure to treat female urinary incontinence. Eur Urol 45:203-207, 2004.

Cindolo L, Salzano L, et al: Tension-free transobturator approach for female stress urinary incontinence. Minerva Urol Nefrol 55:89- 98, 2003.

De Leval J, Waltregny D. New surgical technique for treatment of stress urinary incontinence TVT-Obturator: new developments and results. Surg Technol Int 2005;14:212–21.

Enzelsberger H, Schalupny J, Heider R, Mayer G. TVT versus TOT – a prospective randomized study for the treatment of female stress urinary incontinence at a follow-up of 1 year. Geburtshilfe Frauenheilkd 2005;65:511

Latthe P, Patodi M, Constantine G. Transobturator tape procedure in stress urinary incontinence: UK experience of a district general hospital. J Obstet Gynaecol 2009;27:177–80

Phillippe Grise, Stephane Droupy, Christian Saussine, phillippe Ballanger, Francois Monneins, Francois Hermieu Jean, Gerard Serment, Pierre Costa. Transobturator tape sling for female stress incontinence with polypropylene tape and outside-in procedure: prospective study with 1 year of minimal follow – up and review of transobturator tape sling. Source. 2006;68(4):759–763

Farhat Nissar Khan, Arif Hamid, Baldev Singh Wazir, Mohammed Saleem Wani, and Zahoor Ahmad. An Evaluation of Use of Trans-Obturator Tape (TOT) Sling Procedure in the Current Surgical Management of Female Stress Urinary Incontinence Int J Health Sci (Qassim). 2008 July; 2(2): 118–125.

Pardo Schanz J, Ricci Arriola P, Tacia Femandez XI, Betancourt Ortiz E. Transobturator tape (TOT) in the treatment of stress incontinence. A three year experience with 200 patients. Actas Urol Esp.2007;31(10):1141–1147.

Isabelle Kaelin-Gambirasio, Sandrine Jacob, Michel Boulvain, Jean-Bernard Dubuisson, Patrick Dällenbach Complications Associated with Transobturator Sling Procedures: Analysis of 233 Consecutive Cases with a 27 Months Follow-up BMC Womens Health 2009

Arun Chawla Transobturator tapes are preferable over transvaginal tapes for the management of female stress urinary incontinence Indian J Urol. 2009 Oct-Dec; 25(4): 554–557.

Campbell walsh urology 10th edition.2011. Slings: Autologous, Biologic, Synthetic, and Midurethral ch.73 pp 2157 – 2163.