Introduction: Involuntary loss of urine caused by raised intraabdominal pressure during exercise, coughing, or sneezing is known as stress urinary incontinence (SUI). Urinary incontinence affects over a quarter of women between the ages of 30 and 60, with SUI accounting for roughly half of the cases. Aging, smoking, straining, obesity, and COPD are all risk factors that may result in incontinence. Conservative therapy such as lifestyle changes, pelvic floor muscle training, bladder training, and medications are used as the first line of treatment for SUI. Surgery is recommended for patients who have not improved with conservative measures. Many surgical procedures are described to correct SUI. The essential premise in the therapy of SUI is to create functional kinking of the mid-urethra during episodes of raised intra-abdominal pressure to ensure adequate suspension. Two important sling methods are developed in the last two decades. Transobturator vaginal tape (TOT) technique is anatomically accurate and has the potential to reduce obstruction and postoperative voiding dysfunction. For the surgical treatment of SUI, these mid-urethral sling techniques became the gold standard.
Aims: To study the postoperative complications, outcomes, and quality of life of patients undergoing TOT.

Subjects and methods: This study is conducted  retrospectively from January 2020 to December 2022 on  30 genuine SUI patients, who underwent transobturator sling surgery in private Hospitals of Lahore and Islamabad.The patients underwent all baselines and special examinations, such as an urodynamic study and a cystopanendoscopy. For the first  3-4 months, patients were treated with conservative therapy such as lifestyle changes, bladder training, pelvic floor exercise, and medications.  All the patients who had failed or were dissatisfied with conservative treatment underwent the TOT treatment.

Results: In total,  30 patients were assessed in this study. The patients ranged in age from 29 to  58 years old, with a mean age of 39.9 years. All of the patients experienced involuntary urine leakage during straining, with 18 patients having grade II symptoms and others having symptoms for more than 3 years. Preoperatively, six (25%) of the patients had a minor cystocele, which was cleared after surgery. Diabetes mellitus/hypertension were present in seven  patients. ALPP ranged from 94 to 110 cm of water. All patients had maximal flow rate of more than 20 mL/second and a PVRU of less than 50 mL. The quality of life improved after surgery.
Conclusions: TOT sling is a successful surgical treatment option for SUI, with a good success rate, patient satisfaction, minimal morbidity, and a shorter hospital stay. Patients endure and accept TOT surgery well, and it provides a long-term cure for SUI patients. We advocate TOT as the therapy of choice for SUI because of its safety, ease of use, short surgical time, speedier recovery, minimum problems, and high success rates

The quality of life improved after surgery from a mean of 12.4 to 2.1. Urine flow rate was more than 20 mL/second in 19 patients (79.1%) after surgery, and 15–20 mL/second in 5 patients (20.8%) which improved after 3 months to more than 20 mL/second. In 20 (83.3%) patients, PVR urine was less than 50 mL, and in 4 (16.6%), it was between 50 and 100 mL. At 6-month follow-up, 22 (91.6%) patients were completely satisfied with the surgical outcome, while 2 (8.3%) patients were only moderately satisfied

Conclusions: TOT sling is a successful surgical treatment option for SUI, with a good success rate, patient satisfaction, minimal morbidity, and a shorter hospital stay. Patients endure and accept TOT surgery well, and it provides a long-term cure for SUI patients. We advocate TOT as the therapy of choice for SUI because of its safety, ease of use, short surgical time, speedier recovery, minimum problems, and high success rates.

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