Transobturator Route: In the transobturator approach, the sling (Transobturator Tape – TOT) is placed through a small cut made in the vagina over the mid-point of the urethra. The two ends of the sling are passed from the vagina through this cut, going on the either side of the urethra via the Obturator foramen (see picture), to exit through two small cuts made in the groin (inner thigh).
The sling (or tape) prevents leakage by supporting the urethra. Once the sling is in position, tissue grows through the holes in the weave and so anchors the sling in position. This may take about 3 to 4 weeks.
- Urinary tract infections
UTI can be easily treated with a course of antibiotics.
Bleeding to the extent of needing blood transfusion is very rare. Sometimes blood can get collected in the area through which tape passes. This usually resolves by itself and rarely may need a evacuation procedure.
- Urgency and urge incontinence
About half of the women notice an improvement in urgency symptoms also, but these symptoms can even worsen following a mid-urethral sling procedure in about 5 % cases. This can managed with medications.
- Difficulty in passing urine (voiding difficulty)
Voiding difficulty may occur in 1-5% of patients, often because of edema (swelling) around the urethra or pain or discomfort. It will become normal within 7-10 days. If the problem does not resolve on its own, then you may need loosening or cutting of sling (about 1% cases).
- Sling exposure
In about 2-4% cases, the sling can erode and appear in the wall of the vagina a few weeks, months, or years after an operation. You may develop vaginal bleeding, discharge, or pain with intercourse. Management would involve either recovering the tape or removing the part of tape that is exposed.
- Bladder or urethral Injury
Bladder or urethral perforation can occur in 1-5% cases. A check cystoscopy (Looking into the bladder and urethra) is always done after placing the sling to make sure there is no such injury. These injuries are minor and heal spontaneously without the need of any intervention. This would not interfere with the success of the surgery.
- Your hospital stay will be about two to three days.
- For the first two weeks, you should avoid any strenuous activity, straining at stools, or heavy lifting (no more than 5 kg).
- After two weeks, you may start to return to everyday activities but, if you have a very physical job, work out in a gym or do a lot of running, you should wait a further two weeks (four in total).
- You should practice sexual abstinence for 3 months after the procedure.
- Mid-urethral Sling procedures for Stress Incontinence IUGA 2020.
- Synthetic Mid-urethral tapes for Stress Incontinence BAUS 2018