TOT- slings can successfully cut down the incidence of stress incontinence in women over the age of 40

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  • They live under continuous fear of embarrassment, especially when it negatively impacts their daily social activities.

If you are a female over the age of 40, and are experiencing stress incontinence, you are not alone. In 2015, studies have shown that more than 30% of women around the globe have problems with urine control, causing involuntary urine leaks from the bladder with a cough, laugh or sneeze. Many women assume stress urinary incontinence is just a natural part of aging or an inevitable consequence of having children. They live under continuous fear of embarrassment, especially when it negatively impacts their daily social activities. Due to these misconceptions, many women remain unaware that stress urinary incontinence is a common and treatable medical condition.

“Stress incontinence is a common problem,” said Dr. Manaf Al Hashimi, Consultant Urologist and Head of Department of Urology, Burjeel Hospital Abu Dhabi. “It occurs when pelvic muscles supporting the bladder and urethra have been damaged or weakened, so that they may not hold the urethra in its correct position, hence allowing the urine to leak out of the bladder when they cannot withstand the pressure the body experiences during sneezing, coughing or exercising.

“The condition is observed in women ages 40 and above, and can be caused by several factors such as childbirth, menopause, obesity, high impact activities or heavy lifting done over a period of time, chronic illnesses that cause sneezing and coughing, previous pelvic surgery or hormonal conditions. Women who experience symptoms of stress incontinence can confirm the condition with the medical history, clinical and ultrasonic examination in addition to Urodynamic study,” he explained.

Dr. Al Hashimi says the condition is treatable. “Women are often shy about seeking treatment or opening up about their condition. However, this is a common problem and awareness about the issue can make a big difference to how the patient deals with stress incontinence. Urologists can also suggest a range of solutions to treat the condition, depending on the severity of the problem. These could include Kegel exercises to strengthen the pelvic floor muscles, regulating fluid consumption and scheduling toilet visits as well as lifestyle changes that include losing weight and cutting out smoking and alcohol consumption. However, if stress incontinence disrupts every day activities and is unmanageable, surgery is the recommended solution.

Dr. Al Hashimi said that the latest surgical options offer a high rate of success; these revolutionary techniques are now available in the Middle East, at Burjeel Hospital in Abu Dhabi. “We use the minimally invasive TOT-Sling (trans obturator tape) procedure to lift a woman’s sagging bladder or urethra back into its normal position. It involves placing a thin band of tape under the urethra. The tape supports the urethra and bladder like a sling or hammock. The support provided by TOT- sling can often ease or correct urine leakage. The benefit of using a TOT sling is that it lessens the chance of injury to the bladder, bowels or blood vessels in the area that can happen with other ways of treatment. The incisions are also not visible with no scarring,” he said.

During the procedure, which takes around 30-35 minutes, the surgeon makes small incisions in the groin, another small one in the vagina, and passes the tape, which is a slim band of synthetic material, through these incisions, taking it around the urethra to lift and support the urethra and bladder.[ads1]

During surgery, the surgeon will adjust the tape to ensure the right amount of support. Post surgery, the tape stays in place due to the friction between the tape and the surrounding tissues; it is also not visible. The stitches seal the cuts and dissolve in a few days. We recommend a few days of rest after the surgery to ensure the success of the procedure. The patient is advised not to do any heavy lifting or strenuous activity after the procedure. Care is also recommended to avoid infections and other complications.

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