TOT (Transobturator Tape) Surgery
Surgery for stress urinary incontinence — leaking when you cough, sneeze or lift — in which a narrow tape is placed beneath the urethra to restore its support.
Last medically reviewed: October 6, 2026 — Assoc. Prof. Dr. Müslüm Ergün
Private Online Consultation
A private, one-to-one video consultation by appointment, without visiting the clinic. Especially for patients who value privacy.
- Procedure time
- 20–40 minutes
- Anesthesia
- Spinal or general anaesthesia
- Hospital stay
- Day case – 1 night
- Stay in Türkiye
- 5–7 days
- Catheter duration
- Usually a few hours – 1 day
- Return to work
- 1–2 weeks (desk work), 4–6 weeks (heavy work)
- Flight clearance
- After the review appointment
About the condition
Stress incontinence is involuntary leakage at moments when pressure inside the abdomen rises — coughing, sneezing, laughing, lifting, climbing stairs. The cause is not the bladder but weakening of the structures that support the urethra. Childbirth, the menopause, chronic cough, constipation and weight all contribute.
TOT (transobturator tape) restores that support by placing a narrow, soft tape beneath the mid-portion of the urethra. The tape does not squeeze the urethra; it simply lies beneath it like a hammock at the moment pressure rises and prevents the channel from moving downwards. A small incision in the anterior vaginal wall and one small exit point in each groin are used.
THERE IS NO RIGHT OPERATION WITHOUT THE RIGHT DIAGNOSIS. There are three main types of leakage: stress (with pressure), urgency (not reaching the toilet in time) and mixed. TOT addresses only the STRESS type. If urgency is the real source, a sling will not deliver the expected benefit and may even worsen the urgency. The type of symptom is therefore established in detail before surgery.
THE QUESTION OF MESH MUST BE DISCUSSED OPENLY. The tape is a synthetic material. Some countries have introduced restrictions and there has been public debate about vaginal mesh; most of that debate concerns the large-surface meshes used for PROLAPSE, not the narrow mid-urethral tape used for incontinence. Even so, the patient must be told before surgery that the tape is a permanent implant and can rarely cause pain, erosion or the need for removal. If a surgeon will not discuss this, seek a second opinion.
SURGERY IS NOT THE FIRST OPTION. Pelvic floor exercises, weight loss, treating constipation, stopping smoking and treating a chronic cough come first. Properly taught pelvic floor exercise gives measurable benefit in many women. This step should not be skipped; skipping it also makes post-operative expectations unrealistic.
THE PLAN CHANGES IN WOMEN WHO WANT CHILDREN. Because symptoms may return after delivery, surgery is usually deferred in women planning a pregnancy. That is not a refusal; it is an attempt to make the result last.
TOT and TVT are two sling methods working on the same principle; the difference is the route the tape takes through the body. TOT passes through the groin (the obturator foramen), TVT behind the pubic bone (retropubic). Both are established, and the choice depends on anatomy, previous surgery and the intrinsic closing strength of the urethra.
Who is it suitable for?
May be suitable
- Women who leak when pressure rises — coughing, sneezing, lifting
- Women who gain insufficient benefit from pelvic floor exercises
- Women whose symptoms restrict daily life, social life or exercise
- Women in whom stress-type leakage has been confirmed by examination and testing
- Women who have completed their family
May not be suitable
- Women whose real problem is urgency (overactive bladder) — a sling will not deliver the expected benefit
- Women planning a pregnancy: surgery is deferred until after delivery
- Women with untreated urinary infection: the infection is treated first
- Women who do not empty the bladder fully and have a high residual volume — this is assessed first
- Women with significant prolapse, in whom a sling alone may not be enough; the plan is made together
- Women with mild symptoms who have not yet tried pelvic floor exercise
Technology used
- Mid-urethral sling tape (transobturator route)
- Pad test and bladder diary to measure symptoms objectively
- Uroflowmetry and post-void residual measurement
- Urodynamics in selected patients — to distinguish stress from urgency
- Cystoscopy where required
- Clinical assessment of the pelvic floor muscles
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remotely
Initial assessment
The type of your symptoms (with pressure or with urgency), obstetric history, previous surgery, your medication and any gynaecological or urological reports are reviewed. You may be asked to keep a bladder diary for a few days.
- Day 1
Examination and tests
Gynaecological examination, cough test, uroflowmetry, post-void residual, urinalysis and culture. Urodynamics if required. If the culture grows an organism, surgery is postponed.
- Day 2
Surgery
Under spinal or general anaesthesia a small incision is made in the anterior vaginal wall, the tape is placed beneath the mid-urethra and brought out through each groin, where its tension is set. Setting that tension is the most critical step: leaving it too tight makes voiding difficult.
- Days 2–3
Discharge
Most patients go home the same or the following day. Before discharge we check that you are voiding comfortably and that no significant urine remains in the bladder.
- Days 4–7
Review
The wound, the stream and the residual volume are assessed. The return flight is planned for after this review.
- Week 6
Assessment of the result
Return to sexual activity and to heavy exertion is discussed at this point. How far the symptoms have improved is judged by pad use.
Method comparison
| Criterion | TOT (transobturator) | TVT (retropubic) | Bulking agent |
|---|---|---|---|
| Route of the tape | Through the groin | Behind the pubic bone | No tape |
| Risk of bladder injury | Lower | Relatively higher | Very low |
| Groin or thigh pain | Reported more often | Less often | Not expected |
| Difficulty voiding | Less often | Reported more often | Uncommon |
| Invasiveness | Moderate | Moderate | Low |
| Durability of the effect | Long-term data available | Long-term data available | Usually shorter; may need repeating |
| Permanent implant | Yes | Yes | No |
| Hospital stay | Day case – 1 night | Day case – 1 night | Day case |
The right question is not "which is stronger" but "which trade-off suits me". If you do not want a permanent implant, say so plainly; the options change accordingly. Where the urethra’s own closing strength is weak, the choice of method also differs.
Risks
- DIFFICULTY VOIDING: if the tape is left too tight the stream weakens, the bladder does not empty fully and a catheter may be needed temporarily. A small number of women need the tape loosened or divided
- NEW URGENCY: some women develop frequency and sudden urgency after surgery. It is usually temporary; some need medication
- PAIN RELATED TO THE TAPE: pain in the groin or inner thigh can occur. It usually settles within weeks; in a small number it persists
- EROSION: the tape becoming exposed through the vaginal wall or, rarely, into the urinary channel. It shows as discharge, bleeding or a partner feeling something during intercourse, and requires a further procedure
- Urinary tract infection
- Injury to the bladder or urethra during surgery — uncommon, and repaired in the same sitting when recognised
- Bleeding and haematoma
- SYMPTOMS NOT FULLY RESOLVING, OR RETURNING OVER TIME: a sling aims to reduce leakage; no method can guarantee permanent and complete dryness
- The tape is a permanent implant, and removing it later is harder than the original operation
Alternatives
- Pelvic floor exercises — properly taught, they give measurable benefit in many women; this is the first step
- Pelvic floor physiotherapy and biofeedback — for women who struggle to perform the exercises correctly
- Lifestyle measures — weight loss, treating constipation, stopping smoking, treating a chronic cough
- Vaginal pessary — for women who do not want, or are not suitable for, surgery
- Urethral bulking injection — less invasive; the effect is usually shorter-lived and can be repeated
- TVT (retropubic sling) — the same principle with the tape taking a different route
- Autologous fascial sling — made from the woman’s own tissue, for those who do not want synthetic material or who have had a mesh problem
- Treatment of the bladder where urgency predominates — behavioural therapy, medication or bladder Botox, rather than a sling
Recovery
First 48 hours
Tightness and mild pain in the groin are usual. Drink plenty. Inability to pass urine, fever or heavy bleeding require immediate contact.
Week 1
Ordinary daily activities are fine; lifting and straining are avoided. Constipation is prevented — straining is the single most damaging thing in the first weeks.
Weeks 2–4
Return to desk work usually falls here. Walking is free; running, weights and abdominal exercise wait.
Week 6
Return to sexual activity is usually discussed after this point and after the review appointment.
Month 3
The result becomes clear. The change in pad use is the most intelligible measure of it.
Long term
Weight gain, chronic cough and constipation all contribute to symptoms returning. Continuing pelvic floor exercises after surgery helps protect the result.
Frequently asked questions
Will my leaking stop completely?
The aim is to reduce leakage markedly and to come close to removing the need for pads. No method can guarantee permanent and complete dryness; choose a centre that measures the result by pad use rather than one that promises dryness.
Is mesh safe?
The mid-urethral tape used for incontinence differs from the large-surface mesh used for prolapse and has established use. It is nonetheless a permanent implant and can rarely cause pain, erosion or the need for removal. If a surgeon takes you to theatre without discussing these risks, seek a second opinion.
I do not want synthetic material — are there alternatives?
Yes. An autologous fascial sling made from your own tissue, urethral bulking agents, a pessary and pelvic floor physiotherapy are all options. Say what you prefer at the outset and the plan is built around it.
Will I have difficulty passing urine afterwards?
Usually not, when the tension of the tape is set correctly. If it is left too tight the stream weakens and the bladder does not empty fully, which is why the residual volume is measured before discharge. A small number of women need the tape loosened.
I also have urgency — will this operation fix that?
No. TOT addresses leakage with pressure only. Where urgency predominates a sling does not help and may make it worse. In mixed symptoms, which component predominates is established before surgery and the plan follows from that.
I am planning to have children — can I have surgery now?
Usually it is not advised. Symptoms may return after delivery and the benefit of the operation can be lost. The plan is deferred until after you have completed your family.
When can I go back to work?
Usually 1–2 weeks for desk work. For jobs involving heavy lifting, 4–6 weeks. Straining and lifting early on can directly undo the result.
Will it affect my sex life?
Usually not adversely; for many women the opposite, because the fear of leaking is gone. Return to sexual activity is generally discussed after six weeks and after the review. Report any pain, or anything your partner feels, without delay.
Can the tape be removed later?
It can be removed if necessary, but that is harder than the original operation and complete removal is not always possible. A permanent implant is therefore a decision to take knowingly from the start.
Do I really have to try exercises first?
With mild and moderate symptoms, yes. Properly taught pelvic floor exercise gives measurable benefit in many women and surgery may not be needed. A plan that skips this step is incomplete.
How long should I stay in Türkiye?
Usually 5–7 days. Because the review is carried out here, plan your return flight for after that appointment.
What documents should I send?
Any urodynamics result, uroflowmetry and post-void residual, gynaecological examination notes, reports of previous surgery, a urinalysis and your medication list. A bladder diary kept over a few days is also very useful.
Articles on this topic
Scientific sources
- EAU Guidelines on Non-neurogenic Female LUTS — European Association of Urology
- Sağır S, Başgut Ö, Tunçekin A, Ergün M, Turğut Ö. Comparison of the Transobturator Tape and Minisling Methods in the Treatment of Stress Urinary Incontinence. Archivos Españoles de Urología, 2025.
This page is for general information only and is not a substitute for medical advice.
Let's talk about this treatment
Message us on WhatsApp with your questions or fill in the pre-assessment form.
Pre-assessment form
Leave your details and our team will get back to you shortly.
Other treatments
Overactive Bladder and Urgency Incontinence
A sudden, hard-to-defer need to pass urine, going frequently, and sometimes not getting there in time. Treatment is stepwise, and most women improve markedly without needing medication or surgery.
Learn moreTesticular Cancer: Why Acting Early Changes Everything
The commonest solid cancer in young men, and one that responds very well to treatment. If you have noticed a painless lump, do not wait — delay turns a readily treatable disease into a harder one.
Learn moreStress Urinary Incontinence: the Treatment Options
Leaking urine when you cough, sneeze or exercise. The type has to be established first, and treatment should begin with the least invasive step — surgery is not the first option.
Learn more