TVT (Tension Free Vaginal Tape) & TOT (Trans Obturator Tape). Over the past 12 years the TVT procedure has revolutionised the treatment of stress incontinence, and given very good results. Complications are very rare and in most cases this has remained the proven treatment of choice. Before reading this page I would suggest reading the TVT page to get the background on this, the established, successful and main technique, by clicking on this link. What then are the TVTO and TOT ? Why change a very successful technique? During a conventional TVT we make 2 tiny cuts at the bottom of the tummy just above the bone and then pass the tape behind the bone and in front of the bladder as shown below. The advantages appear be a slightly quicker recovery rate, less chance of disturbing the bladder, ease of adding to other prolapse surgery and even fewer possible complications such as difficulty emptying the bladder and bleeding. It must be stressed however that complications are minimal with the conventional TVT. The down side however is that the follow-up to date is shorter with fewer operations performed. To date (July 2010) I have performed over 970 of these operations. Collecting the data and auditing the results shows a comparable success rate to the conventional TVT in most women at this stage, and when combined with certain other repair operations it has definite technical advantages. It is also less tension dependent which means that women have even fewer difficulties emptying the bladder and go home quicker. Because of this we can do it under a general anaesthetic and as a day case more reliably. At Robert Peel Hospital (Tamworth) this has been my preferred approach, all women having been able to go home the same day.