Transobturator tape (TOT) is a vaginal procedure used to correct stress urinary incontinence. This is a narrow strip of synthetic material placed in the vaginal skin to support the urethra. The hammock cradles the urethra and gives it support helping it to close more tightly at times of stress. This is done through a small vaginal incision below the urethra, where a permanent mesh-like material is inserted and anchored to the inner aspect of the thigh on each side. The mesh remains as a permanent sling under the urethra, preventing incontinence when straining or coughing.
Transvaginal tension free tape (TVT) is a variation of the same principle. In TVT, the tape is anchored to the abdominal muscles above the pubic bone. These minimally invasive procedures have almost completely replaced the classic operation of colposuspension.