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Urogynaecology · UK

Trans-Obturator Tape (TOT) - a mid-urethral sling for stress incontinence.

A short strip of polypropylene mesh placed under the mid-urethra through two small groin incisions, to stop leakage on coughing, sneezing or exercise. Consultant urogynaecology-led, with a proper conservative workup first and a full mesh-safety conversation before you consent.

See indicative pricing
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Indicative pricing

What a private TOT sling costs in the UK.

Indicative ranges across our partner units.

In short

£7,500–£11,500, home the same day.

Procedure Indicative range
TOT sling (day-case, all-inclusive) £7,500–£11,500
TVT sling (retropubic route) £8,000–£12,500
Urethral bulking (Bulkamid) £3,500–£5,500
Autologous fascial sling £12,000–£18,000
Burch colposuspension (open or laparoscopic) £11,000–£16,000
Urodynamics only £550–£900
Urogynaecology consultation only £300–£500

Prices vary by hospital, by the consultant, and by whether continence surgery is combined with prolapse repair.

The problem

The right operation, the right time, and a proper mesh conversation.

Stress incontinence surgery is where UK women have been let down before. Physiotherapy skipped, mesh consent rushed, alternatives buried. We put all three back in the room.

  • Have you been given real physiotherapy?

    A supervised, dosed, twelve-week programme with a pelvic floor physiotherapist - not a leaflet and a good luck.

  • Have you seen the mesh-free alternatives?

    Bulkamid, autologous fascial sling, Burch colposuspension - shown side-by-side, honestly, before you decide.

  • Do you know how to raise a complaint?

    The national mesh database, the pathway if problems appear years later - written down on your discharge letter, not left to Google.

When it helps

When a TOT sling is the right step.

The situations we see most, plus the one situation that means specialist mesh-complications review, not another sling.

  • Stress leakage on cough or sneeze

    A predictable pattern - leakage on exertion, not urgency - confirmed on examination and, where needed, urodynamics.

  • Exercise-induced leakage

    Running, jumping, HIIT, trampolining - leakage that is stopping activity despite months of pelvic floor work.

  • Failed conservative treatment

    A supervised physiotherapy trial of at least three months, adequately dosed, without enough benefit to live with.

  • Post-partum stress incontinence

    Leakage persisting a year or more after delivery in a woman who has finished her family - assessed and counselled fully.

  • Mixed incontinence, stress predominant

    Where urodynamics shows stress leakage as the dominant driver even when there is some urgency.

  • Combined with prolapse repair

    Where a symptomatic prolapse is being repaired at the same sitting and continence is a separate, proven issue.

  • Family completed, well-informed

    Sling surgery is not recommended before childbearing is complete - future pregnancy affects outcomes.

  • Red flag: pelvic pain, dyspareunia, mesh symptoms

    Pain, painful sex, recurrent UTI or exposure with a previous mesh needs urgent specialist review - not another sling.

Procedure options

Route, tension, and whether mesh at all.

What each option involves - the obturator route, the retropubic route, and the growing list of mesh-free alternatives that many UK women now prefer.

  • Trans-obturator tape (TOT / TVT-O)

    The obturator route - tape passed through the groin, avoiding the retropubic space. Slightly lower bladder injury risk, slightly higher groin pain risk than TVT.

  • Retropubic tape (TVT)

    Tape passed up behind the pubic bone through two small suprapubic exits. Slightly better long-term dry rate, slightly higher risk of bladder puncture.

  • Urethral bulking (Bulkamid)

    Injectable gel into the urethral wall - no mesh, no cuts. Lower dry rate but a strong option for women who want no permanent implant.

  • Autologous fascial sling

    A strip of your own rectus sheath used as the sling. No synthetic mesh at all. Longer operation, longer recovery, but chosen more often since the mesh pause.

  • Burch colposuspension

    The vaginal wall lifted and sutured to the pectineal ligament, open or laparoscopic. A durable, mesh-free option with a long UK track record.

  • Pelvic floor physiotherapy

    Non-surgical, first-line, and often enough. Should be supervised, adequately dosed, and given a real trial before any sling.

  • Continence pessary

    A ring or dish that supports the mid-urethra during activity. Useful for exercise-specific leakage or as a trial before surgery.

  • When surgery is not the answer

    Urgency incontinence, overactive bladder, unmanaged constipation and untreated pelvic organ prolapse each need their own pathway first.

Safety and recovery

What to expect afterwards - honestly.

Sling surgery is well established but not routine - UK women deserve the full picture of both the good and the bad before consent.

  • The UK mesh context

    Since 2018, mid-urethral mesh slings have been paused in the NHS and are only offered privately under strict conditions with informed consent and an MDT. We follow the same standard.

  • Bladder injury and voiding difficulty

    Bladder puncture is under 1% for TOT (higher for TVT). Difficulty emptying the bladder can happen in the first days - usually settles, occasionally needs the tape loosened.

  • Groin, thigh and pelvic pain

    Some tenderness for a few weeks is normal. Persistent groin or thigh pain, especially with the obturator route, needs assessment - not ignored.

  • Vaginal exposure and pain during sex

    Tape can occasionally erode into the vagina causing discharge, bleeding or dyspareunia. Reported rates 1–2%. It is treatable, sometimes with tape removal.

  • Infection and haematoma

    Wound and urinary infection under 5%. A small groin haematoma is uncommon but can be uncomfortable for a week or two.

  • Recurrence and repeat surgery

    Long-term dry rates of around 80% at 5–10 years. A minority need repeat surgery or bulking later on.

  • Sex, exercise and driving

    No penetrative sex or heavy exercise for six weeks. Driving when you can perform an emergency stop without pain - usually a week.

  • HRT, weight and constipation

    Local vaginal oestrogen post-menopause, weight optimisation and treated constipation all improve continence outcomes.

  • Red flags after surgery

    Unable to pass urine, heavy vaginal bleeding, fever, spreading redness or new severe pain need the same-day team, not a routine call.

Reading your notes

Your notes in four parts. Read the last one first.

Whether you have a TOT, a TVT or a bulking procedure, the note the urogynaecologist writes keeps to the same shape.

  1. 01 Header

    Indication and route

    Why the sling was done, TOT or TVT, tape type, GA or spinal, and any concurrent procedures.

  2. 02 Technique

    Anatomy and findings

    Vaginal incision, obturator passage, tension-set at cough, cystoscopy findings and voiding trial.

  3. 03 Findings

    Voiding trial and discharge

    Post-void residual, whether the catheter came out on the day, and any teach-in for self-catheterisation.

  4. 04 Impression

    Follow-up and mesh registry

    Read this first: your six-week review, the direct line for problems, and your entry on the national mesh registry.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Continence surgery is usually covered when clinically indicated and the patient has completed conservative treatment. Mesh cases need extra pre-authorisation.

Frequently asked

Everything we get asked about TOT slings.

Quick answers on approach, recovery, cost and long-term outcome.

  • Is TOT the same as TVT?

    Both are polypropylene mid-urethral tapes. TOT (trans-obturator) passes through the groin around the pubic bone; TVT (retropubic) passes up behind the pubic bone. TVT has slightly better long-term dry rates and a slightly higher risk of bladder puncture; TOT has a slightly higher risk of groin pain. Your urogynaecologist tailors the choice to your anatomy and previous surgery.

  • Is mesh still allowed in the UK?

    Mid-urethral mesh slings have been paused in the NHS since 2018 following the Cumberlege review. Private surgery is possible but only under strict conditions - full informed consent, exhaustion of conservative options, an MDT decision, and registration on the national mesh database. We work only with units that follow this pathway.

  • What are the mesh-free alternatives?

    Urethral bulking (Bulkamid) is a quick, injectable, no-mesh option. Autologous fascial slings use a strip of your own tissue. Burch colposuspension is a durable, mesh-free operation with decades of data. Which suits you depends on your anatomy, activity, and how much recovery time you can give.

  • How long is recovery from a TOT sling?

    Home the same day for most women. Back to office work in a week. No heavy lifting, no penetrative sex and no heavy exercise for six weeks. Full continence effect settles by six to twelve weeks.

  • How much does a private TOT sling cost in the UK?

    Roughly £7,500–£11,500 all-inclusive for TOT, £8,000–£12,500 for TVT, and £3,500–£5,500 for urethral bulking. Autologous fascial sling and Burch are £12,000–£18,000.

  • What happens if the sling causes problems years later?

    Late problems - tape exposure, pain, painful sex, voiding trouble - need specialist mesh-complications review, not a repeat sling. UK mesh centres perform partial or complete tape removal where indicated. We can refer directly if you are worried about a tape put in elsewhere.

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