The tension-free vaginal tape was introduced in 1995 by Ulmsten and Petros for female stress urinary incontinence (SUI) (1). In the following decades, mid-urethral tapes (MUT) became the gold-standard procedure for stress urinary incontinence (2). There are many reported serious delayed complications associated with them (3). Surgical management of these complications may involve total excision, with its associated risks.

Our video presentation demonstrates a technique  for Total   Trans-Obturator Tape (TOT) removal, demonstrating both vaginal and extra-vaginal (groin) dissection.

The Trans-Obturator Tape (TOT) removal was recorded and the video edited to comply with the ICS conference submission requirements. A specialised medical illustration consent was obtained from the patient for the use and publication of the recording. The music piece used in the video is part of the public domain and is credited at the end of the video.

Case presentation

We present a case of 59 years old patient who was referred with history of ongoing vaginal and groin pain. EUA and cystoscopy showed no mesh perforation into the urinary tract. MRI pelvis showed no signs of infection or sinus/fistula formation. 
Case was discussed in multidisciplinary team meeting which agreed to support the patient’s choice for mesh removal. We present the techniques of vaginal and extra-vaginal (groin) dissection used in the total TOT removals.

Patient had uneventful recovery and reported significant improvement of symptoms at follow-up.

Within the appropriate setting and with right expertise, significant intra-operative complications are rare during total TOT removals. We present a video presentation demonstrating a case of  Trans-Obturator Tape (TOT) removal, through vaginal and groin dissection.

Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7(2):81-5; discussion 5-6.
Rogo-Gupta L, Litwin MS, Saigal CS, Anger JT, Urologic Diseases in America P. Trends in the surgical management of stress urinary incontinence among female Medicare beneficiaries, 2002-2007. Urology. 2013;82(1):38-41.
Ross S, Tang S, Eliasziw M, Lier D, Girard I, Brennand E, et al. Transobturator tape versus retropubic tension-free vaginal tape for stress urinary incontinence: 5-year safety and effectiveness outcomes following a randomised trial. Int Urogynecol J. 2016;27(6):879-86.