How Effective Is the Transobturator Tape (TOT-V) Procedure in the Management of Stress Urinary Incontinence in Low-Resource Settings? A Descriptive Study

Stress urinary incontinence (SUI) is a common gynaecological condition affecting both premenopausal and postmenopausal women, and although Burch colposuspension has traditionally been considered the gold standard for moderate to severe SUI, mid-urethral sling procedures such as the transobturator tape (TOT-V) remain widely used in low-resource settings due to their lower cost, technical simplicity, and favourable recovery profile. This study evaluated the clinical efficacy, safety, and patient-reported outcomes of the transobturator tape (TOT) procedure for stress urinary incontinence, with follow-up extending to two years, and demonstrated consistently high levels of patient satisfaction ranging from 81% to 85% across all time points, comparable to international success rates of 80–90%. Early postoperative outcomes were particularly favourable, with 85% of women reporting satisfaction at discharge, reflecting rapid symptomatic relief and the minimally invasive nature of the procedure, while medium- and long-term follow-up showed sustained benefit with only a modest decline in satisfaction by two years, consistent with published long-term data. Comparative analysis supports the advantages of TOT over retropubic tension-free vaginal tape, including reduced risks of bladder perforation, voiding dysfunction, and vascular injury, albeit with a higher incidence of transient groin pain, and demonstrates outcomes comparable to Burch colposuspension with lower morbidity, shorter operative time, and faster recovery—advantages that are especially relevant in low-resource settings. The complication profile was favourable and aligned with international evidence, with groin pain occurring in 17% of patients and resolving with conservative management, tape erosion observed in 2.4%, and a low recurrence rate of 4.7%, all within or below reported global ranges. The use of the Patient Global Impression of Improvement scale strengthened patient-centred assessment, confirming high subjective benefit that paralleled objective outcomes. Overall, these findings support the TOT procedure as a safe, effective, and well-tolerated surgical option for stress urinary incontinence, with durable outcomes and particular suitability for low- and middle-income settings due to its affordability, minimal resource requirements, and reliable clinical performance.