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Suspension Surgery for Urinary Incontinence (TOT/TVT)

If your doctor has recommended Transobturator Tape (TOT) / Transvaginal Tape (TVT) surgery, it is aimed to relieve or alleviate your complaints with urinary incontinence.

Although these surgeries are usually performed with spinal/epidural anesthesia (numbness from the waist), general anesthesia can be applied rarely. This surgery begins with a vaginal incision. A strip made of a synthetic material called polypropylene is placed to support the urethra (the tube that carries urine from the bladder to the outside of the body). If necessary, at the end of the surgery, a urinary catheter or a tampon can be placed inside the vagina to control bleeding. These will be removed in the postoperative period when your doctor deems it appropriate.

To whom are these surgeries (TOT/TVT) performed?

  • People who leak urine by coughing, sneezing, heavy lifting
  • Patients who have had surgery for these reasons before and whose complaints continue
  • Patients who have received drug therapy for urinary incontinence and have not benefited

What are the complications?

  • Bleeding or hematoma formation: Apart from bleeding up to a certain amount and which are considered clinically insignificant, serious and urgent bleeding that requires surgery or blood product transfusion may occur, although rarely. In the case of blood collection between the tissues called hematoma, pain and infection may occur. Hematomas may pass on their own after being followed, or they may need to be evacuated surgically from time to time.
  • Complaints that do not resolve completely, recur, and intensify: Complaints related to urinary retention or pelvic organ prolapse may not fully recover or reappear despite these interventions-procedures-surgeries. In this case, drug therapy or an additional surgery may be recommended.
  • Difficulty in bladder emptying: This problem may arise after the surgery for various reasons (depending on the surgical intervention performed or the tissues responding differently to the intervention than expected). In this case, I may need to use a catheter/catheter for a long time to empty the bladder or an additional surgery may be needed. In some cases, it may be necessary to loosen or remove the inserted synthetic strip.
  • Erosion of the surrounding tissues by the synthetic tape: The tape, which is a foreign substance, can erode/erode the surrounding tissues over time. In this case, complaints such as pain, recurrent infections, bleeding can be seen. Surgical intervention may be required for its treatment.
  • Pain: Severe pain is not expected in the postoperative period. A significant part of the pain subsides or goes away within a few days after the operation. Rarely, this period may be extended. Painkillers are used to treat pain. In some rare cases, prolonged leg/hip pain or difficulty/limitation of leg movements may occur due to nerve damage. In this case, drug therapy is applied.
  • Dyspareunia(Painful sexual intercourse): Short or long term dyspareunia may be seen after the operation. It may be recommended not to have sexual intercourse for a while, and various drugs.
  • Unable to complete the procedure: The procedure may not be completed due to technical difficulties or physical obstacles, additional sessions may be required to complete the treatment.
  • Infection (inflammation): Various inflammations can be seen after the surgery. Acute and chronic urinary tract infections can be encountered as it is worked close to the urinary tract. In this case, appropriate antibiotic therapy is given. In wound infection, appropriate antibiotic treatment is started by taking wound culture, if necessary, the wound is left open for a temporary period, and followed by dressing as often as necessary. In case of urinary tract, wound or other infection, appropriate cultures are taken and appropriate antibiotic treatment is started according to the results. In case of abscess formation, the abscess must be evacuated or completely removed by surgery. Synthetic foreign substance used can cause inflammation. The risk of infection may increase due to some patient-related factors (obesity, vascular diseases, diabetes, smoking, immune system disorders, etc.).
  • Fistula formation
  • Emboli (clogged veins with clots, oil or gas)
  • General Risks: Various complications defined in the medical literature may occur depending on the drugs and medical equipment used during and after the intervention-procedure-surgery. In addition, slight numbness or permanent scarring in the incision area, short or long-term pain-drowsiness due to positioning during applications, diarrhea or constipation, low aeration in the lungs (atelectasis), heart rhythm disorders, sudden cardiac arrest, allergies, loss of limb and organ functions. Although undesirable situations such as deficiencies, paralysis, brain damage and epilepsy are rare, they are situations that you should be aware of and may encounter. These may require antibiotic treatment or additional surgeries; Your treatment may need to be continued in the intensive care unit.
  • Blood and Blood Product Transfusion and Its Risks: Bleeding may occur during the intervention-procedure-surgery. After these bleedings or for the correction of anemia, blood and blood products, which we call whole blood, erythrocyte, fresh frozen plasma, thrombocyte suspension, can be applied. Depending on the application of these products; Minor reactions such as fever, itching, rash and other allergic reactions may occur at a rate of approximately 1/100,000. Less than 1/10,000 cases of more serious reactions such as bleeding, decrease in blood pressure, kidney failure or death. The incidence of viral hepatitis and HIV is 1/10,000 – 1/500,000.
  • Risk of Death: The rate of death due to the operation itself or to undesirable conditions after the operation is around 1/10,000.

How is the success of these surgeries (TOT / TVT)?

Significant improvement is seen in 8 out of 10 women who have "Transobturator Tape (TOT) / Transvaginal Tape (TVT)" surgery.

How is the process after the surgery (TOT / TVT)?

You will not be given oral food for a while (average 6 hours) after the operation, you will be fed intravenously. In the postoperative period, you may be asked to walk, breathe deeply, cough, and engage in various activities. During your stay, you will be given various medications by intravenous, intramuscular, subcutaneous, oral or respiratory routes. You will also be informed about the drugs to be given. Similarly, you will be provided with detailed information on blood or blood product transfusions if required. All these measures are aimed at ensuring your recovery in a shorter time and preventing the occurrence of undesirable situations. Although your hospital stay is an average of 2 days (1 night), this period may vary depending on recovery or undesirable conditions. Usually, our patients who return home recover in a period of 2-4 weeks.

Patients should pay attention to after TOT/TVT surgery

  • To use the drugs given after discharge with care
  • Avoiding sexual intercourse for 6 weeks
  • Avoid heavy lifting for at least 2 weeks, avoiding anything that will increase intra-abdominal pressure, such as constipation
  • Consuming vegetables, fruits, whole grain foods
  • Drinking enough fluids (your urine should be clear or slightly yellow)

Emergency situations to be considered after surgery

Under normal conditions, patients are called for control 2 weeks after the operation. However, if any of the following: You need to contact your doctor immediately.

  • Fire
  • Excessive bleeding
  • Dizziness
  • Severe abdominal pain
  • Discharge from the wound or vagina

Pregnancy after "Transobturator Tape (TOT) / Transvaginal Tape (TVT)" surgery

As it is known, pelvic structures may deteriorate during pregnancy. This is particularly evident in women who have given birth naturally. Many gynecologists; performs surgery on women who have completed the child request. Since there is not much scientific evidence about women who become pregnant after having these surgeries, we cannot predict how the surgery will be affected.

If you have been offered these surgeries, you can ask your doctor these two questions?

What is your success in urinary incontinence with this surgery? (Success in this surgery is related to the surgeon's experience and technique. )

Is there anything I can do to increase the success of the surgery? (Quitting smoking, doing Kegel exercises.)

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