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Also known as
Transobturator sling, Transobturator midurethral sling, Transobturator Tape (TOT) Sling, mini-sling
Definition
During a transobturator sling procedure, a surgeon makes a small cut in the vagina and two small cuts in the groin muscles on either side. Using a needle, the surgeon guides each end of a piece of mesh from the vagina to the groin muscles. The mesh forms a sling to support the urethra, the tube that carries urine from the body. The sling is held in place by the soft tissue along its path.¹
Clinical Context
Transobturator midurethral slings are commonly used for the treatment of stress urinary incontinence (SUI), a condition characterized by involuntary leakage of urine during activities that increase abdominal pressure, such as coughing, sneezing, or exercising. This surgical approach was developed to minimize complications associated with retropubic slings, particularly bladder and bowel injuries.¹
Patient Selection Criteria: Transobturator slings are typically recommended for women diagnosed with SUI. Patients who are anxious about synthetic mesh-related complications may opt for autologous transobturator midurethral sling procedures, where the patient’s own tissue (e.g., rectus abdominis fascia) is used instead of synthetic mesh.¹
Surgical Procedures: The transobturator sling procedure involves making a small incision in the vagina and two small incisions in the groin. A mesh or autologous fascia is then guided from the vagina to the groin muscles, forming a sling to support the urethra. The sling is held in place by the soft tissue along its path.¹
Expected Outcomes: Transobturator slings are considered an effective treatment for SUI with low morbidity. Studies have shown favorable outcomes, with significant improvement or cure rates for SUI. While generally safe, potential postoperative complications can occur, though they are less frequent compared to retropubic slings. Long-term data continues to support the safety and performance of transobturator slings.²