Tension-free Vaginal Sling Procedures: Transobturator Tape Procedure

Tension-free vaginal sling procedures: transobturator tape procedure (TOT) is a treatment for urodynamically proven stress incontinence in women. TOT is a minimally invasive procedure that involves the placement of a small piece of polypropylene mesh around the pubic bones underneath the urethra. The urethra is the tube through which urine passes from the bladder to the outside of the body. With the TOT procedure, the tape for the sling is routed through a 3mm incision within both inguinal (groin) folds and through the obturator foramen, the space created by the ischium and pubis pelvic bones. The mesh tape is manually guided through a small incision in the vagina and positioned under the urethra. The ends of the tape are secured to the groin incisions and adjusted just enough that its tension supports the urethra. TOT has been shown to have fewer side effects than the other major tension-free vaginal sling procedure, called transvaginal tape procedure (TVT). Operative times for TOT vary greatly depending on the findings at the time of surgery. Average times range from 20 to 40 minutes with the patient under local anesthesia plus intravenous sedation, regional, or general anesthesia. TOT is a day surgery or a 23-hour observation surgery.

UAB Urogynecology and Pelvic Reconstructive Surgery provides the highest level of evidence-based care for the full spectrum of women’s pelvic floor disorders. We stand apart from other programs because our board-certified or board-eligible physicians offer the full range of treatment options for women with urinary and bowel incontinence, pelvic organ prolapse, and other pelvic floor conditions. We feature minimally invasive surgical treatments for urinary and bowel incontinence and pelvic organ prolapse, and we collaborate with colleagues in providing nonsurgical options for pelvic floor conditions.

Our urogynecologic and pelvic reconstructive surgeons and physicians are recognized nationally and internationally, including service as president of the prestigious Society of Gynecologic Surgeons, a select member group of more than 250 physicians involved in teaching and practicing advanced gynecologic surgery. In addition, our leadership has been appointed to the National Institutes of Health (NIH) Urologic and Genitourinary Physiology and Pathology Study Section at the NIH Center for Scientific Review.

Urogynecology is all that we do, so you can depend on us to deliver individualized care in a sensitive fashion that fulfills your specialized needs.

Care Providers


Meet the Team: Gena Dunivan, M.D.
Meet the Team: Gena Dunivan, MD
Meet the Team: Tracey Wilson, M.D.
Meet the Team: Tracey Wilson, MD
Dr. Wilson specializes in caring for women with voiding dysfunction and pelvic floor issues. At a young age, she was inspired to be a physician by the excitement of medicine and the satisfaction of helping treat those in need.
Robot-Assisted Surgery with Warner Huh, M.D.
Robot-assisted Surgery at UAB

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