Urinary Incontinence Is Not Destiny: TOT/TVT Surgeries and Current Solutions

Laughing, sneezing, lifting a heavy bag, or running in the park with your child… These ordinary actions can turn into a major source of anxiety for many women. There are thousands of women who withdraw from social life, hesitate to drink water, and are forced to constantly use pads due to the fear of “Did I leak urine?”, “Did my clothes get wet?”, or “Will there be a smell?”.

Unfortunately, urinary incontinence is seen in society as “a natural result of aging” or “the price of having given birth.” However, as Assoc. Prof. Dr. Cengiz Andan, I would like to state clearly: Urinary incontinence is not destiny; it is a medical condition with a treatment. And with today’s technology, getting rid of this problem is possible with an operation lasting only 15-20 minutes.

Why Do I Leak Urine? Let’s Name the Problem

Before starting treatment, it is necessary to determine the type of incontinence. There are two types most commonly seen in women:

1. Stress Urinary Incontinence: It is the leakage of urine, drop by drop or more, in situations where intra-abdominal pressure increases (coughing, sneezing, laughing, heavy lifting, climbing stairs). The cause is usually the weakening of the muscles and connective tissue supporting the bladder neck. It is the most common type and the group that responds best to surgical treatment (TOT/TVT).
2. Urge Urinary Incontinence: It is the situation of a sudden severe need to go to the toilet and leaking before reaching it. It is also known as “overactive bladder.” It is generally related to the involuntary contraction of bladder muscles rather than muscle weakness, and medication is the priority in its treatment.

In some patients, both conditions are seen together (Mixed Type).

Underlying Causes of Urinary Incontinence

• Difficult Births: Traumatic processes such as giving birth to a large baby, giving birth multiple times, or vacuum-assisted delivery can tear or loosen pelvic floor muscles.
• Menopause: With the decrease in estrogen hormone, tissues in the vagina and urinary tract lose their elasticity and thin out.
• Genetic Factors: Some women’s connective tissue is congenitally looser (collagen deficiency).
• Obesity and Chronic Diseases: Excess weight constantly puts a load on the bladder by increasing intra-abdominal pressure. Chronic cough (asthma, smoking) and constipation also increase the risk.

The Definitive Solution: TOT and TVT (Sling) Surgeries

In the past, urinary incontinence surgeries were operations performed with an open incision from the abdomen, with low success rates and difficult recovery. However, Sling Operations developed in the last 20 years have created a revolution in this field.

The methods we apply most frequently in our clinic are TOT (Transobturator Tape) and TVT (Tension-free Vaginal Tape) operations.

How is the Procedure Performed?

The logic of these surgeries is quite simple: A hammock-shaped supportive tape (synthetic mesh) is placed under the urethra (urine channel) exiting the bladder.

• Incision-Free: The procedure is performed entirely through the vaginal route. There is no incision on the abdomen.
• Takes Short Time: It is completed in an average of 15-20 minutes.
• Mechanism: This placed tape supports the urethra from below (like a tap washer) when you cough or laugh, preventing urine leakage.

What If There Is Bladder Prolapse (Cystocele)?

In most patients with urinary incontinence complaints, the complaint of a “mass palpable from the vagina,” that is, bladder prolapse (cystocele), is also seen. In this case, we perform a combined procedure in a single session. We both lift the sagging bladder and tighten the vagina (Vaginoplasty / Cystocele Repair) and place the TOT/TVT tape to prevent urinary incontinence. The patient gets rid of both problems with a single anesthesia.

A New Life After Surgery

The sentence our patients say most frequently after surgery is: “I wish I hadn’t waited all these years.”

• Rapid Discharge: You are usually discharged on the same day or the next morning.
• Painless Process: Pain is minimal; you can return to your daily life within 3-5 days.
• Self-Confidence: The necessity of using pads disappears. You can wear whatever you want, laugh without fear, and do sports.

For us, success is not just ensuring you hold urine; it is giving you back the joy of life you lost.

Frequently Asked Questions (FAQ)