TOT (Transobturator Tape)

By Dr. Joseph Berenholz

At some point in their lives, many women experience a condition known as stress urinary incontinence. Through childbirth, aging or other causes, pelvic muscles weaken, allowing for loss of urine when coughing, sneezing, laughing, or engaging in physical or sexual activities. In some cases, this lack of support can even lead to pelvic organ prolapse, i.e. the protrusion of an organ into the vagina. This condition can take several forms:

  • Cystocele – Cystocele is the medical term for bladder prolapse, or the herniation of the bladder through the wall of the vagina.
  • Rectocele – Rectocele is the medical term for rectal prolapse, or the herniation of the rectum into the vagina.
  • Urethrocele – Urethrocele is the medical term for urethra prolapse. This sometimes occurs along with cystoceles, in which case it is called a cystourethrocele.


Each condition is caused by a weakening of the ligaments and muscles that support each structure within the pelvis. A rectocele, for example, is weakened pelvic support of the rectum and thinning of the rectovaginal septum. Procedures that treat the condition strengthen existing support or provide new support that keeps each organ in place.

This weakening of support muscles and ligaments along the pelvic floor is called pelvic relaxation. In a woman’s body, the pelvic floor holds the bladder and uterus in place above the vaginal canal. When pelvic relaxation occurs, the bladder and uterus can sag into the vagina, causing one or more of the above conditions.

There are several different treatment options for these conditions, but the procedure that has gained the most adherents in recent years is the transobturator tape sling, aka TOT sling. A mesh tape is positioned beneath the urethra via small incisions, an outpatient procedure that typically requires an office visit of one hour. The additional support provided by the sling has been shown to eliminate urinary incontinence in over 80% of patients who undergo the procedure.

As an ob/gyn with 20+ years of experience, Dr. Joseph Berenholz has the knowledge and expertise needed to recommend the best course of treatment for urinary incontinence, including TOT slings. To find out more about Dr. Berenholz and the TOT procedure, please call (248) 359-3200 or toll-free 888-593-8780.