Urinary incontinence—There are mainly two types of incontinence: Urge and stress. While urge incontinance is defined simply as an involuntary leakage of urine after a sudden intense urge; stress incontinance is involuntary leakage when your bladder is under pressure, like when your laughing, sneezing, jumping or even doing exercise like pilates. Specifically stress urinary incontinence—is a common issue affecting many women, especially after childbirth or as they age. One of the most effective and minimally invasive treatments for this condition is a sling procedure, particularly the transobturator tape (TOT) surgery.

What is a Sling Procedure?

A sling procedure involves placing a small piece of surgical mesh (a type of supportive material also used to repair hernias) under the urethra, which is the tube that carries urine out of the body. The sling acts like a hammock to support the urethra and bladder neck, helping prevent leakage during activities that put pressure on the abdomen. It also helps maintain the right angle between urethra and bladder in order not to leak any urine.

Top Facts About Prof. Cem Iyibozkurt, M.D.:

  • Harvard Medical School Surgical Leadership Program Graduate.
  • Professor of Obstetrics & Gynecology specializing in Minimally Invasive & Robotic Surgery.
  • 20+ Years of Experience in Gynecologic Surgery.
  • Certified in Advanced Robotic Surgical Techniques.
  • Ph.D. in Molecular Medicine.

What Makes Transobturator Tape (TOT) Different?

There are several types of sling procedures, and TOT is one of the most commonly performed today. In TOT surgery, the mesh is placed through small incisions made in the groin area and passed under the urethra through a natural space called the obturator foramen. This approach avoids going behind the pubic bone, which can lower the risk of certain complications such as bladder, bowel and neurovascular injuries.

Benefits of TOT Surgery:

  • Minimally invasive. Small incisions mean a faster recovery.

  • Effective. Most women experience significant improvement or complete resolution of leakage.

  • Quick recovery. Many patients return to normal activities within a few days to a week.

  • Performed under local or spinal anesthesia. Reducing the need for general anesthesia in most cases.

What to Expect During and After the Procedure:

The surgery typically takes about 30 minutes and can often be done as a day case, meaning you go home the same day. Mild discomfort, bruising, or a feeling of tightness in the groin is normal for a few days. You’ll be advised to avoid heavy lifting, exercise, and sexual activity for a few weeks to allow healing. In order for the TOT mesh to bond with your body, you would be advised to refrain from activites like lifting heavy stuff and use appropriate supplements to relieve constipation if you have any.

Are There Any Risks?

Like any surgical procedure, there are potential risks. These may include infection, difficulty emptying the bladder temporarily, pain in the groin or thigh area, or in rare cases, mesh complications. However, serious problems are very uncommon, and your surgeon will discuss these with you beforehand.

What is the success rate of this surgery?

TOT surgery has a success rate of more than 90% in short term and studies have shown that many women may continue to enjoy the benefits of this procedure.
Long term success rates lay around 70-80% around 10 years after the surgery.

Is It Right for You?

If you’re dealing with stress urinary incontinence and conservative treatments (like pelvic floor exercises) haven’t helped, sling surgery—especially TOT—might be a good option. This type of surgery can also be used together with prolapsus surgeries, if you have prolapsed uterus and bladder. A consultation with a specialist can help determine if you’re a suitable candidate.