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TOT Sling Complications

The TOT sling was developed to make the placement of the suburethral mesh tape sling less complicated and to also minimize some of the risks known to occur with the passage of the abdominal needles for placement of the TVT type sling (ie bladder, bowel, major vascular injury). Instead of passing needles blindly through the abdominal wall, the needles are passed through the groins, which is a potentially much safer needle pass.

Many of the complications listed with the TVT sling can also be encountered with the TOT sling,however secondary to the needles being passed through the groin instead of the abdominal wall, it typically does not result in abdominal pain issues. Secondary to the needles being passed through the groin and the mesh tape being pulled through the groin muscles, it can result occasionally in pain in the groin region.

Below are examples of TOT Slings

*indicates company provider

Unique Complications with the TOT sling:

Groin and/or Vaginal Pain:

Secondary to the mesh tape being placed through the groins and passing near the obturator nerve, rarely groin or leg pain can be encountered. Post operatively many women may have discomfort and some pain in the groins for a short period of time, however this should improve rather quickly. If it does not or worsens, then this should be evaluated as soon as possible. If the nerve has been irritated it is important to release or remove the sling sooner than later. This typically is accomplished through a vaginal and groin approach and should only be done by an expert in the field of vaginal mesh complications as usually the entire mesh sling on the side of the pain will need to be removed, including the portion in the groin. If the sling is just causing pain with intercourse or vaginal pain, then many times it will only need released or removed through a small vaginal incision (see treatment section).

Groin pain is known to occur more frequently with an “inside-out” type approach versus passing the needle from the “outside-in” approach. With this approach the needle is passed through a small incision in the groin and guided into the vaginal incision with direct finger contact away from the danger area of the nerve (ie Obtryx *Boston Scientific; Align-TO, Uretex-TO *Bard Urology). The TVT-O procedure is the only procedure that uses the inside-out approach and has been shown to get closer to the nerve because of this.

Groin infection/abscess:

This again is a very RARE complication and typically does NOT occur with a Type I mesh (such as used with Monarc, TVT-O, Bard, etc), however a procedure by the name of ObTape (Mentor) was released several years ago and did NOT use a Type I mesh. Complications such as infections, abscesses, and rejection of the tape did occur and resulted in severe complications for many women. The procedure has been taken off of the market, however we are still seeing late complications with this procedure. If the patient is not having any problems with the mesh, it does not need to be removed, however they need to be aware that if that start having any issues with vaginal discharge, pain, etc they may need the sling removed.

Other complications such as extrusion, obstruction, voiding dysfunction and erosion can still occur as with the TVT approach, however typically are more rare.

Pain, Urinary Leakage S/P Preggie, TOT Sling /
Urinary Retention post TVT-O Sling, recurrent prolapse /
Leg, Groin Pain post-TOT Sling / TOT Sling - Leg Pain, Leakage / Avaulta/TOT Sling Complication – Severe vaginal and buttock pain, pain w/ intercourse / Vaginal Pain, Painful intercourse post-TOT Obtryx Sling

 

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