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The term TOT or TVT-O refers to the transobturator tape. It was used to treat stress urinary incontinence. In 2001 it was a new method of inserting the polypropylene tape through the obturator foramen.

In 2006 National Institute for Health and Care Excellence (NICE) stated:

“Synthetic slings using a retropubic ‘top down’ or a transobturator foramen approach are recommended as alternative treatment options for stress incontinence if conservative management has failed. Provided that women are made aware of the lack of long term outcome data”.

The TOT or TVT-O did not have proven long term efficacy. Due to its placement there was a risk of injury to the obturator nerve and adductor nerves and muscles of the inner thigh.

Risks of TOT or TVT-O

In 2007 a systematic review of transobturator and retropubic tapes was published in the RCOG journal and it state that the “risk of vaginal erosion and groin pain is higher with TOT or TVT-O”.

Vaginal injuries and erosion were reported twice as much in the TOT or TVT-O group. The pain in groin and thigh was higher in the TOT or TVT-O tapes than in TVT.

Any reasonable gynaecologist or urologist offering TOT or TVT-O surgery in the UK would have been aware of the risks. They should have discussed the risks and benefits of TVT compared with TOT.

Obturator nerve damage causes chronic groin pain which is permanent. This causes leg pain and mobility issues. Many women have vaginal pain and pain on intercourse. For many it prevents intercourse entirely. Some women had mesh erosion needing further surgery.

Removal of TOT or TVT-O

It was known that groin pain was not amenable to any effective therapy. Removing mesh from the groin is highly complex, entailing dissection around the adductor tendons of the thigh and the obturator nerve. Such surgery is hazardous, outside the expertise of gynaecologists and not widely available.

This should have been known to any reasonably competent urologist or gynaecologist offering TOT or TVT-O surgery.

The mesh, once inserted into the groin, was permanent and irreversible. This was known by any reasonable urologist or gynaecologist and a patient would expect to be informed of this. They were not.

Women should have been told that there were other surgeries available and the difference between a TVT, colposuspension, urethral injectables, or sling and the TOT or TVT-O. They were not.

If you have been affected by a TOT or TVT-O mesh then get in touch with Dr Victoria Handley today by calling our Solicitors for Women Freephone number on 0800 470 2009 or email

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