Mid-urethral sling (TVT, TOT) for stress urinary incontinence

Stress urinary incontinence means leaking urine when coughing, sneezing, laughing, lifting or exercising. It is caused by weakened support of the urethra, often after childbirth or with age. It is common and responds well to treatment. A mid-urethral sling is a thin strip of synthetic material placed without tension under the middle part of the urethra. It acts like a hammock that supports the urethra during effort and prevents leakage. It is inserted through a small incision in the vagina and two small incisions either above the pubic bone (TVT, retropubic technique) or in the groin crease (TOT, transobturator technique). Before offering surgery, the gynaecologist makes sure the leakage is truly related to effort, because leaks caused by sudden urges need other treatments. A urodynamic assessment, carried out at the clinic's urodynamic investigation centre, is often requested. Pelvic floor exercises are generally tried first. At Clinique Pasteur Tunis, this operation is performed by gynaecologists experienced in pelvic floor surgery, working with the clinic's urologists when needed. It is done under a short anaesthetic, with a brief hospital stay.