TOT 8/4: A Way to Standardize the Surgical Procedure of a Transobturator Tape

Suburethral tapes are placed "tension-free" below the urethra. Several studies reported considerable differences of the distance between urethra and tape. These distances ranged from 1 to 10 mm amongst different patients. This either caused urethral obstruction or had no effect on urinary incontinence. Therefore, we decided to standardize the procedure by placing a Hegar dilator of 8-millimeter diameter in the urethra and another Hegar dilator of 4-millimeter diameter between the urethra and the tape during transobturator tape placement. Using that simple technique, which we named "TOT 8/4," we observed that 83% of the tapes were placed in the desired distance between 3 and 5 millimeters below the urethra.