Mid-Urethral Sling — TVT / TOT
Minimally Invasive Sling Procedure to Cure Stress Urinary Incontinence
What is Mid-Urethral Sling — TVT / TOT?
Mid-Urethral Sling procedures — Tension-free Vaginal Tape (TVT) and Trans-Obturator Tape (TOT) — are the gold-standard surgical treatments for female stress urinary incontinence. A polypropylene mesh tape is placed under the mid-urethra to provide a backboard of support, preventing urine leakage during coughing, sneezing, or exercise. TVT uses a retropubic route; TOT uses a trans-obturator route with a lower risk of bladder injury. The procedure is performed under general or spinal anaesthesia with a hospital stay of Day Care / 1 Day. Success rates reach >85% in appropriately selected patients at experienced centres.
How the Procedure Works
Patient Positioning
The patient is positioned in lithotomy under spinal, general, or local anaesthesia with sedation.
Vaginal Incision
A 1.5–2 cm midline anterior vaginal wall incision is made at the mid-urethral level.
Tape Passage
For TVT, two curved trocars are passed from the vaginal wound, through the retropubic space, and out above the pubic symphysis. For TOT, trocars pass through the obturator foramen.
Tension Calibration
Tape tensioned to achieve the correct support — confirmed with cystoscopy for TVT or flow testing.
Tape Trimming & Closure
The tape arms are trimmed flush with the skin entry wounds. The vaginal incision is closed with absorbable sutures.
Outcomes
Who Needs This Treatment?
- →Women with urodynamically confirmed stress urinary incontinence — leakage on coughing, sneezing, or exercise.
- →Those who have failed pelvic floor physiotherapy for at least 3–6 months.
- →Patients with genuine stress incontinence from urethral hypermobility.
- →Women with mixed incontinence where the stress component is dominant.
- →Those seeking a day-case, minimally invasive solution with the highest success rate.
- →Patients who have consented to synthetic mesh implantation after full counselling.
"TVT and TOT slings are among the most successful procedures in urology. For properly selected patients with stress incontinence, we can offer over 85% cure rates with a brief day-case operation."
— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon
Common Questions
Frequently Asked
Not sure which treatment is right for you?
Book a consultation with Dr. Vipin Reddy and get a personalised treatment plan.