TOT surgery is a type of bladder suspension operation. It is usually successful in women with stress urinary incontinence (stress urinary incontinence).
It is one of the safest operations with the lowest complication rate and the highest surgical success, in which the bladder (bladder) neck and urinary duct (urethra) are suspended. TOT stands for Trans Obtuator Tape.
Stress-type urinary incontinence problem is a problem that we frequently encounter with the rupture and weakening of the pelvic floor muscles in women with advancing age, such as difficult births, giving birth to a large baby, giving many births. As these problems increase, it may cause an increase in urinary incontinence in women.
When the problem of urinary incontinence becomes chronic, it negatively affects the woman's daily life, quality of life, psychology and sexual life. It may cause her to feel uncomfortable in the community and confined to the house.
TOT surgery to remove the bladder neck helps to eliminate the urinary incontinence problem effectively and successfully, so that the person can return to their daily life comfortably.
It is known as sling surgeries using a synthetic mesh (mesh).
It is defined as urinary incontinence when women lift heavy weights, cough, sneeze and laugh. It is usually caused by weakening of the muscles and tissues that make up the pelvic floor or damage during childbirth.
The pelvic floor is a strong anatomical region consisting of muscles and connective tissue, which is attached to a bone structure formed by the pelvis in front and the coccyx in the back, almost like a hammock that wraps the lower base. Pelvic floor muscles support the urinary bladder (bladder) urinary duct (urethra) lower intestines, uterus and vagina.
It prevents organ prolapse. The urethra, the urinary duct, which allows urine to be expelled from the bladder, can be held strongly by the pelvic floor at a certain angle at the entrance to the bladder. And this prevents urine from leaking out when intra-abdominal pressure increases. However, if the connective tissue and muscles of the pelvic floor are damaged or weakened, the urethra cannot be supported properly.
The angle where it exits from the bladder is distorted, so in situations that increase intra-abdominal pressure, such as coughing, laughing, sneezing, walking, intra-abdominal pressure puts pressure on the urethra and urine leakage occurs.
With TOT surgery, a sling applied to the bladder neck and middle urethra prevents urinary incontinence that occurs when intra-abdominal pressure increases. It is the most preferred method among urinary incontinence surgeries all over the world.
TOT surgery is performed in the general operating room under general or spinal anesthesia. A small incision is made on the anterior wall of the vagina one centimeter below the urethra. A permanent synthetic material is placed here using a specially produced patch-mesh to support the middle part of the urethra, which we call the midurethra, and to correct the hypermobile urethra.
Both arms of the mesh are removed from the sides of the groin by making a small incision on both sides of the groin, passing through the channel we call the obturator canal with a special hook. In this way, the bladder and urethra are lifted upwards. The mesh used remains in the body for life, it is compatible with the body.
The operation takes an average of 20-30 minutes. When different combinations of surgeries are added to this surgery, such as vaginal tightening, labiaplasty and correction of uterine prolapse, then the operation time may be prolonged.
There is no need to remove the vaginal sutures as self-melting sutures are used to suture the cut vaginal tissues. This is favorable for the need for more permanent and long-lasting surgical success. In addition, additional lifestyle changes and medical drug support treatments can be added to the treatment after surgery depending on the type of urinary incontinence.
TOT surgery is preferably performed on patients who have completed their births and completed the number of children. A repeat pregnancy and birth process will negatively affect the success of the surgery. If there is another pregnancy afterwards, it is recommended to have a cesarean section, not a normal delivery.
According to recent publications, the success rate of the surgery is between 80 and 96%. Success rates vary depending on the experience of the physician performing the surgery, the quality of the mesh, the compatibility of the mesh with the tissue and whether other types of urinary incontinence accompany the event.
The complication rate is extremely rare in TOT surgeries performed by specific pervic floor surgeons and urogynecologists working in the field of TOT surgery. Possible complications; bladder injury, voiding dysfunction, urge urinary incontinence, vascular injury, erosion of the mesh through the vagina, pelvic pain, persistent urinary incontinence and pain during sexual intercourse are very rare complications.
If we list the risks of TOT surgery one by one;
You will be hospitalized overnight after TOT surgery. For 24 hours, you will have a permanent catheter in your bladder, which will be removed when you are able to urinate on your own.
A tampon is usually inserted into the vagina. This tampon in the vagina is removed together with the urinary catheter. It is normal to have some bleeding in the form of leakage after the procedure and to continue bleeding for a week to ten days.
After TOT surgery, it may take one and a half to two months for the stitches used in the vagina to be absorbed. Therefore, sexual intercourse should be avoided until the stitches are absorbed. Since there is a risk of infection in this surgery, as in every surgery, personal hygiene and care should be given importance. Resting, resting, eating a healthy and balanced diet and following the recommendations of the physician will make it easier for the patient to overcome this process.
Personal care and hygiene are important after surgery. The genital area should be washed with boiled and cooled water after urination and defecation, or antiseptic special wound care products should be used, and then dried with a cotton cloth without rubbing. If there are any signs of infection, consult a physician immediately.
During the recovery period, especially for a week to ten days, constipation that increases intra-abdominal pressure should be avoided, foods with plenty of fiber should be consumed, diseases that cause chronic cough, such as asthma, such as hafizam, should be treated.
It is recommended to take a bath in the form of standing shower 48 hours after TOT surgery. For one month after the surgery, it is necessary to stay away from activities such as pools, spas and hot tubs where water can enter the vagina.
After TOT surgery, she should take the medications prescribed by her physician on time and in dose. Physician controls should not be interrupted and heavy lifting and exercises that will increase intra-abdominal pressure should be suspended for a month during the recovery period.
It is quite normal to feel pain and discomfort in the area where the bladder is located for the first week or two after the operation. Due to the stitches and edema in this area, problems such as burning during urination, inability to reach the toilet, lack of relief after urination and dripping are considered normal for the first week. This period can sometimes last up to a month. During this period, these problems can be easily overcome with painkillers prescribed by the physician and adequate water intake.
The recovery process after TOT surgery is very fast. Our patients can usually return to their daily lives, activities and jobs after a week and ten days. Some vaginal bleeding and discharge in the form of leakage after the surgery is normal. It is also important to pay attention to fluid intake at regular intervals during the day so that you do not develop a urinary tract infection.
You should avoid excessive consumption of coffee, tea, cigarettes and alcohol as they can irritate the bladder receptors and bladder wall. You can drink two to three cups of tea a day and Turkish coffee once or twice a week.
The suspension material used during TOT surgery, the patch-mesh mesh, is placed on the anterior vaginal wall in the middle of the urethra. The nerve stimulation in this area is affected to some extent and there are studies showing that sexual pleasure is affected for three to six months. Sexual intercourse is possible two months after the surgery.
Studies have shown that; Since the anxiety of urinary incontinence during sexual intercourse has disappeared, women have gained more sexual motivation, and since they have regained their sexual self-confidence, the pleasure and satisfaction they receive from sexual intercourse have increased.
The price of TOT surgery may vary according to the experience of the doctor and the combined surgeries to be performed. First of all, I recommend that you choose a urogynecologist doctor working in the field of urinary incontinence and have a preliminary examination. Then you can have price information by learning the surgeries he recommends to you. You can call us for TOT surgery price information.
The technique of the surgery to be performed and the combined surgeries (vaginal tightening perineoplasty perineoplasty uterine prolapse labioplasty vulva filling, removal of uterine prolapse) cause the price of the surgery to be very variable.
After the type of urinary incontinence is determined, surgery is selected. Surgical application in every type of urinary incontinence is the biggest obstacle to achieving satisfactory results.
In urinary incontinence surgeries, more successful results are usually obtained when applied to women with pelvic organ prolapse. You can learn which surgery will be performed and the details of the operation by contacting the Urogynecology doctors working in this field. This operation is a personalized process.