What is a Transobturator tape placement?

Transobturator tape placement (TOT) is when mesh (prolene) tape is placed underneath the urethra. It acts as a layer of support so that the urethra is closed off when there is laughing, coughing, sneezing and exercising.

When is this surgery used?

To treat stress urinary leakage, such as a loss of urine with coughing, sneezing, laughing or exercise.

How do I prepare for surgery?

  • Depending on your health, we may ask you to see your primary doctor, a specialist, and/or an anesthesiologist to make sure you are healthy for surgery.
  • Some medications need to be stopped before the surgery.
  • Smoking can affect your surgery and recovery. Smokers may have difficulty breathing during the surgery and tend to heal more slowly after surgery. If you are a smoker, it is best to quit 6-8 weeks before surgery. If you are unable to stop smoking before surgery, your doctor can order a nicotine patch while you are in the hospital.
  • You will be told at your pre-op visit whether you will need a bowel prep for your surgery and if you do, what type you will use. The prep to clean your bowels will have to be completed the night before your surgery.
  • You will need to shower at home before surgery. Instructions will be provided at your pre-operative appointment.
  • Do not wear makeup, nail polish, lotion, deodorant, or antiperspirant on the day of surgery.
  • Remove all body piercings and acrylic nails.
  • If you have a “Living Will” or an “Advance Directive”, bring a copy with you to the hospital on the day of surgery.
  • Most women recover and are back to most normal activities in 4-6 weeks. You may need a family member or  friend to help with your day-to-day activities for a few days after surgery.

What can I expect during the surgery?

  • Once in the operating room, you will be given either a spinal or general anesthesia before the surgery to keep you from feeling pain. The choice of anesthesia is a decision that will be made  based upon your history and your wishes.
  • If a general anesthesia is given, after you are asleep and before the surgery starts:
    • A tube to help you breathe will be placed in your throat.
    • Another tube will be placed in your stomach to remove any gas or other contents to reduce the likelihood of injury during the surgery. The tube is usually removed before you wake up.
    • A catheter will be inserted into your bladder to drain urine and to monitor the amount of urine coming out during surgery. The catheter will stay in until the next day.
    • Compression stockings will be placed on your legs to help prevent blood clots in your legs and lungs during surgery.
  • The inside of the bladder will be examined with a camera after the surgery, to be certain there were no bladder injuries.

What are possible risks from this surgery?

Problems can occur, even when things go as planned. You should be aware of these possible problems, how often they happen, and what can be done to correct them.

Possible risks during surgery include:

  • Bleeding: If there is excessive bleeding, you will be given a blood transfusion unless you have personal or religious reasons for not wanting blood.
  • Conversion to an open surgery requiring an up and down or Bikini incision: If a bigger open incision is needed during your surgery, you may need to stay in the hospital for one or two nights.
  • Damage to the bladder, ureters (the tubes that drain the kidneys into the bladder), and to the bowel: Damage occurs in less than 1% of surgeries. If there is damage to the bladder, ureters, or to the bowels they will be repaired while you are still in surgery.
  • Death: All surgeries have a risk of death.  Some surgeries have a higher risk than others.

What happens after the surgery?

You will be taken to the recovery room and monitored for one hour before going to your hospital room. Depending on the length of your surgery, you may not be able to eat or drink anything until the next morning or you will be started on a liquid diet.

You may have cramping, or feel bloated.

You will:

  • Be given medications for pain and nausea as needed.
  • Still have the tube in your bladder.  The tube will be left in until the next morning.
  • If you are at a high risk for blood clots, a blood thinning medication may be given to you during your hospital stay.
  • Have the compression stockings on your legs to improve circulation. The stockings will stay on until you are actively walking. 
  •  Start walking as soon as possible after the surgery to help healing and recovery.
  • Be restarted on your routine medications. Be instructed to use a small plastic device at your bedside to help expand your lungs after surgery. 
  • Stay in the hospital for 1-2 days.

Possible risks that can occur days to weeks after surgery:

  • Blood clot in the legs or lungs: Swelling or pain, shortness of breath, or chest pain are signs of blood clots.
  • Infection:  Bladder or surgical site infection.  This may cause fever, redness, swelling or pain. 
  • Urinary symptoms:  Failure to cure the bulge, develop urine leakage, and inability to urinate without a catheter.
  • Bowel obstruction:  A blockage in the bowel that causes abdominal pain, bloating, nausea and/or vomiting
  • Scar tissue: Tissue thicker than normal skin forms at the site of surgery
  • Pain: Pain with intercourse.

Call your doctor right away if you experience any of the following :

  • develop a fever over 100.4°F (38°C)
  • have nausea and vomiting
  • develop a rash
  • have pain with urination
  • start bleeding like a menstrual period or (and) are changing a pad every hour
  • have severe pain in your abdomen or pelvis that the pain medication is not helping
  • have heavy vaginal discharge with a bad odor
  • have chest pain or difficulty breathing
  • leak fluid or blood from the incision or if the incision opens
  • develop swelling, redness, or pain in your legs
  • You may need menstrual pads at home, due to some bleeding and spotting that will occur after the surgery.

Bleeding:

  • Spotting is normal.
    • Discharge will change to a brownish color followed by yellow cream color that can continue for up to four to eight weeks.
    • It is common for the brownish discharge to have a slight odor because it is old blood.

Urination:

  • Your urine stream may be slower. Some women are temporarily unable to empty the bladder completely. If you are unable to empty your bladder after surgery we will teach you how to do so before you go home, or you may go home with a catheter tube in place. If the catheter is left in place, you will need to discuss with your doctor when the catheter can be removed.

Medications:

Pain: Medication for pain will be prescribed for you after surgery. Do not take it more frequently than instructed.

Stool softener: Narcotic pain medications may cause constipation. A stool softener may be needed while taking these medications.

Activities:

Energy level:  It is normal to have a decreased energy level after surgery.   Once you settle into a normal routine at home, you will slowly begin to feel better.  Walking around the house and taking short walks outside can help you get back to your normal energy levels more quickly. 

Climbing: Climbing stairs is permitted, but you may require assistance when you first return home. 

Lifting: For 6 weeks after your surgery you should not lift anything heavier than a gallon of milk. This includes pushing objects such as a vacuum cleaner and vigorous exercise.

Showers: Showers are allowed within 24 hours after your surgery.  Tub baths are encouraged 24 hours after surgery.

Intercourse:   No sexual activity for 8 weeks after surgery. 

Driving: The reason you are asked not to drive after surgery is because you have be given pain medications.  Even after you stop taking pain medications; driving is restricted because you may not be able to make sudden movements due to discomfort from surgery.

Exercise: Exercise is important for a healthy lifestyle.  You may begin normal physical activity within hours of surgery.  Start with short walks and gradually increase the distance and length of time.

Work: Most patients can return to work in 6 weeks after surgery. 

Please contact your doctor if you have any questions or concerns before or after your surgery.