New T.O.T. Sling is a Safer, More Effective
Solution for Urinary Stress
Approximately 85% of all
women in childbearing years and beyond experience some degree of
stress urinary incontinence. This leakage, which often occurs with
coughing, laughing, sneezing, running or jumping is not only
embarrassing but also tends to prohibit many activities of today's
Until recently the most effective treatment has been the T.V.T.
(Trans-vaginal tape) sling, which is vaginally implanted to provide a
lift-and-secure mechanism to support the bladder.
Like the T.V.T., the new T.O.T. is also inserted vaginally in a ten
minute outpatient surgery. Patients generally leave the outpatient
facility in an hour.
Several improvements in the procedure and the technology indicate that
the T.O.T. sling is the method of choice.
In a 'blind' procedure where the surgeon cannot visualize the area,
the older T.V.T. sling is attached on one side just behind the pubic
bone. This placement has inherent risks due to its proximity to the
bladder, bowel and major blood vessels. Or the sling's placement may
prevent urination, which has to be corrected in an additional
procedure. In addition, the T.V.T. sling is manufactured of woven
mesh, which over time may erode into the urethra.
The new T.O.T. sling is attached underneath the pubic bone using a
smaller, more easily managed needle. Although the sling is placed in
the same position as in the T.V.T., the chance of complications is
greatly diminished during the surgical insertion because of a greater
distance from the vital structures.
Unlike the older sling, the central portion of the new T.O.T. sling
consists of material that can be absorbed, similar to dissolvable
stitches. After approximately 90 days of healing and the formation of
supportive scar tissue, the central portion of the T.O.T. will have
dissolved into the body.
The T.O.T. procedure, which has been used in Europe for more than two
years, is rapidly replacing the older sling procedure. Although no
long term studies exist yet, the prognosis for this new option is
Dr. Lyons worked with its manufacturer, Caldera Medical, in developing
the technology. Learn more about the procedure at
Incontinence May Be Only One Symptom of Pelvic Floor Defects
Childbirth is almost always the initial injury to the structural
integrity of the pelvic floor. This may begin to degrade the proper
interdependent support required for all aspects of the female anatomy
to function as designed.
Often the initial complaint of incontinence spells additional problems
which should be corrected earlier than later. A great advantage
offered by the Center for Women's Care is the correct diagnosis of
pelvic floor integrity. Each patient with incontinence is thoroughly
evaluated. If necessary, the entire pelvic floor can be re-supported
in a single surgery.
Although incontinence is often the most easily recognized symptom of
pelvic floor defects, other conditions include prolapse, which is the
herniation or collapse of the vaginal vault and/or uterus.
Female pelvic tissues are dependent on estrogen for strength and
support. As a woman ages and estrogen depletes, the trauma produced
during childbirth in earlier years can be compounded by weight gain,
lifting or straining, and constipation.
Only rarely does incontinence exist alone. Most defects are clear
upon vaginal examination. Enhanced in-office diagnostics including
ultrasound and urodynamics enable Dr. Lyons to assess accurately each
patient's overall pelvic floor integrity.
The overall health of women is dramatically improved by corrective
medical attention early on in a single minimally-invasive procedure,
because the condition often earmarked by incontinence will degenerate
if left untreated.
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