TOT
What is a transobturator tape (TOT) procedure?This is the procedure for urinary stress incontinence and it is performed under a general or spinal anaesthetic.
A small incision is made on the wall of the vagina and the permanent tape is introduced via the vagina to sit under the urethra. The needles used to place the tape are introduced through small incisions at both sides of your upper inner thigh (see picture). The tape used is a permanent mesh, which will not be dissolved in your body.
Surgery for stress incontinence aims to give you more control over your bladder. It cannot always cure the problem completely.
Why do I need a transobturator tape (TOT)?You will have discussed the options to manage your stress incontinence with your doctor and decided to have a transobturator tape inserted.
TVT
TVT Sling is an operation to treat stress urinary incontinence. Stress incontinence is leakage of urine that occurs with activities which cause an increase in abdominal pressure such as coughing, sneezing, jumping, lifting, exercising and in some cases walking.
This leakage occurs because the muscles at the bladder neck have lost their supports and strength. As a valve mechanism, the urethra (waterpipe) no longer stays closed when extra pressure is put on the bladder.
TVT sling is a minimally-invasive operation requiring three small incisions to insert and position the tape. A 1 cm cut is made on either side of the lower abdomen (tummy) with a 3 cm incision in the vagina to allow the tape to be put in place.
Women are usually in hospital for one night following this type of surgery.
Vesicovaginal Fistula Surgery (VVF)
Vesicovaginal fistulae are usually secondary to obstetrical trauma, pelvic surgery, advanced pelvic cancer, or radiation therapy for treatment of pelvic cancer.
The basic principles for treatment of vesicovaginal fistulae have changed little since the mid-19th century work of Marion Sims. The principles are to ensure that there is no cellulitis, edema, or infection at the fistula site prior to closing the fistula and to excise avascular scar tissue and approximate the various layers of tissue broadside to broadside without tension. A 20th century addition to these principles is that of using transplanted blood supply from the vestibular fat pad, bulbocavernosus muscle, gracilis muscle, or the omentum.
The type of suture used appears less significant when the above principles are followed. In general, we have used the glycolic acid sutures such as Dexon or Vicryl because of their reabsorption and reduced tissue reaction. Many surgeons prefer, however, to use a non-absorbable monofilament suture of nylon or Prolene on the vaginal mucosa. These sutures should not be placed into the bladder mucosa. If they are left in the bladder for long periods of time, urinary stone formation will occur.
The purpose of the operation is to close the vesicovaginal fistula perman