TOT Surgery in İzmir | How Is Urinary Incontinence Treated?

Urinary leakage while coughing, laughing, sneezing, or exercising does not have to restrict your daily life. The TOT procedure, used in the treatment of stress urinary incontinence, involves placing a supportive tape beneath the middle portion of the urethra. Successful treatment, however, requires the type of urinary incontinence to be diagnosed correctly. Prof. Dr. İsmail Mete İtil, a specialist in obstetrics and gynecology, provides personalized diagnosis and treatment while explaining the procedure’s benefits, alternatives, and potential risks associated with the synthetic tape.

What Is TOT Surgery?

TOT stands for “Transobturator Tape.” During the procedure, a narrow synthetic tape is placed beneath the middle portion of the urethra, which is the tube that carries urine out of the body. The tape supports the urethra against increased abdominal pressure during coughing, sneezing, or physical activity, helping prevent urinary leakage.

TOT surgery is primarily performed to treat stress urinary incontinence. It is not, by itself, an appropriate treatment for overactive bladder or urge urinary incontinence, which is characterized by a sudden and intense need to urinate.

Who Is Suitable for TOT Surgery?

Patients who experience urinary leakage while coughing, laughing, or exercising
Patients whose symptoms negatively affect their daily and social lives
Patients without an active urinary tract infection
Patients who can empty their bladder adequately
Patients who understand the benefits and potential risks of the procedure

A more detailed assessment is required for patients who have previously undergone surgery for urinary incontinence or pelvic organ prolapse, those who have significant difficulty urinating, and those whose diagnosis remains uncertain.

Which Tests Are Performed Before TOT Surgery?

Before surgery, the doctor evaluates when and how urinary leakage occurs. A pelvic examination, cough stress test, urinalysis, and measurement of the urine remaining in the bladder after urination may be performed.

Urodynamic testing is not mandatory for every patient. However, it may be required in cases of mixed urinary incontinence, difficulty urinating, previous pelvic surgery, or diagnostic uncertainty. A detailed preoperative assessment should also include the patient’s medical history, urine test results, and ability to empty the bladder.

How Is TOT Surgery Performed?

TOT surgery may be performed under general or spinal anesthesia. During the procedure, a small incision is made in the front wall of the vagina. The synthetic tape is passed beneath the middle portion of the urethra and guided through the obturator region toward the inner groin.

The tape is positioned without tension so that it supports the urethra rather than compressing it. The vaginal incision is closed with sutures, and a temporary urinary catheter may be used when necessary. The procedure generally takes approximately 45 minutes. The duration may vary depending on the patient’s anatomy and whether any additional procedures are performed, although mid-urethral sling operations are usually relatively short.

What Is the Recovery Process After TOT Surgery?

The length of the hospital stay depends on the type of anesthesia used and the patient’s ability to urinate. Before discharge, the medical team confirms that the patient can empty her bladder adequately.

Mild vaginal bleeding, tenderness in the groin, and temporary changes during urination may occur during the first few days. For the period recommended by the doctor, patients should avoid heavy lifting, strenuous exercise, sexual intercourse, and constipation. Returning to daily activities usually takes around three days, although this period may vary according to the physical demands of the patient’s work and the individual recovery process.

What Are the Risks of TOT Surgery?

As with any surgical procedure, TOT surgery involves certain risks. These may include bleeding, infection, injury to the urinary tract or bladder, temporary or persistent difficulty urinating, newly developed urinary urgency, and pain in the groin or thigh.

Less common but important complications include exposure of the synthetic tape inside the vagina, damage to surrounding tissues, and chronic pain requiring removal of the tape. The operation should be performed by an experienced obstetrician and gynecologist to reduce these risks as much as possible. Nevertheless, no surgical procedure can be guaranteed to be entirely risk-free.

Which Doctor Performs TOT Surgery in İzmir?

The diagnosis, surgical planning, and postoperative follow-up for TOT surgery are managed by obstetricians and gynecologists experienced in pelvic floor surgery. With more than 40 years of professional experience, Prof. Dr. İsmail Mete İtil aims to create personalized treatment plans for TOT surgery and for the diagnosis and treatment of all forms of urinary incontinence.

During the examination, the doctor should evaluate not only the presence of urinary leakage but also its type and severity, the patient’s ability to empty the bladder, and accompanying conditions such as pelvic organ prolapse.

TOT Surgery Prices

The cost of TOT surgery may vary according to the characteristics of the tape used, hospital and anesthesia fees, required medical tests, length of hospital stay, and whether additional surgery is needed. The final cost is determined after the examination and the preparation of a personalized surgical plan.

Conclusion

TOT surgery is one of the surgical options intended to reduce stress urinary incontinence in appropriately selected patients. Successful treatment depends on an accurate diagnosis, selection of the appropriate method, detailed discussion of potential risks, and regular follow-up.

For TOT surgery and the treatment of urinary incontinence in women in İzmir, Prof. Dr. İsmail Mete İtil, Specialist in Obstetrics and Gynecology, provides personalized care by evaluating each patient’s symptoms, examination findings, and test results as a whole.

This content is intended for general informational purposes only and does not replace a medical examination, diagnosis, or personalized treatment plan.

Prof. Dr. İsmail Mete İtil | Specialist in Obstetrics and Gynecology