Sling Surgery (TOT/TVT)| Assoc. Prof. Dr. Senad Kalkan

In brief

TOT and TVT are sling operations in which a thin supportive tape is placed under the urethra to treat stress urinary incontinence, the leakage that happens when coughing, sneezing, laughing or exercising. They are not suitable for every type of incontinence; the decision is made after an examination and, where needed, urodynamic testing.

Leaking urine when pressure inside the abdomen rises is common in women and over time can limit exercise, going for walks and social life. In suitable patients this problem can be treated with sling surgery.

What Is the Difference Between TOT and TVT?

Both aim to support the urethra from below; the difference lies in the path the tape takes through the body. In TVT the tape passes behind the pubic bone, while in TOT it passes through the openings in the groin area. Which one suits you is decided by looking at your examination findings, any previous operations and your general health together.

Who Is It Suitable For?

Women who leak urine when coughing, sneezing, laughing or exercising
Those who have not had enough benefit from pelvic floor exercises
Those found to have stress urinary incontinence on examination and testing

Urge incontinence, where you cannot reach the toilet in time, is a different problem and is usually not treated with surgery. Because the two types can be confused or occur together, urodynamic testing is used to tell them apart.

After Surgery

After the operation, we check that the bladder is emptying properly. There may be mild pain or tenderness in the first few days. You will need to avoid heavy lifting and strenuous activity for as long as your doctor advises.

Risks

No operation can guarantee the same result for every patient. Reported complications include new frequent urination, incomplete bladder emptying, the tape wearing through into the vaginal tissue (erosion) and groin pain. The expected benefits and possible risks are discussed in detail before surgery. You can find the steps of the operation in more detail in the article How Is Sling Surgery Performed in Women?

Frequently asked questions

How long does TOT or TVT surgery take?

These are usually short operations. The time depends on the method chosen and whether another procedure is done at the same time.

When can I go back to work after sling surgery?

Most patients can return to a desk job fairly soon. Jobs that involve heavy lifting require a longer wait; the timing is decided at the follow-up visit.

What tests are done before sling surgery?

An examination, urine analysis and a measurement of the urine left in the bladder after passing urine are done, with urodynamic testing if needed. These tests show the type of incontinence and whether the operation is suitable for you.

What kind of anaesthetic is used for TOT or TVT surgery?

General, regional or, in some cases, local anaesthesia can be used. The anaesthetist and surgeon choose the method together according to the patient's condition.

Can incontinence come back after TOT or TVT?

In some patients leakage can return over the years. The likelihood varies with the type and severity of the incontinence and with individual factors, so follow-up continues.

Is the sling tape permanent?

Yes, the tape is placed so that it stays in the body permanently. The possibility that an additional procedure may be needed if a problem develops with the tape is discussed before surgery.

Last updated: 11 November 2026