Prof. Dr. Derya Sivri AydınObstetrician & Gynaecologist
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Urinary incontinence and sling surgery (TOT)

Urinary incontinence is common in women but is not an inevitable part of ageing. Once the type is identified, symptoms can be greatly reduced or cured with lifestyle changes, exercises, medication or a short sling operation.

Written by Prof. Dr. Derya Sivri Aydın
Obstetrician & Gynaecologist, November 2026

Types of urinary incontinence

Stress incontinence

Leaking urine when coughing, sneezing, laughing, bending or exercising. It is linked to weakening of the tissues that support the urethra.

Urge incontinence

A sudden, strong urge to pass urine and not reaching the toilet in time. It is linked to overactivity of the bladder muscle.

Mixed incontinence

Both types occurring together.

First-line treatments

  • Weight loss if overweight
  • Adjusting fluid intake; reducing caffeine, alcohol and fizzy drinks
  • Treating constipation
  • Pelvic floor (Kegel) exercises, with a physiotherapist if needed
  • Bladder training and passing urine at regular intervals
  • Vaginal oestrogen after the menopause

For urge incontinence, medication and, when needed, advanced treatments are used in addition to these steps.

Sling surgery for stress incontinence

For stress incontinence that persists despite exercises, mid-urethral sling surgery is the treatment with the highest success rate. A thin tape is placed under the urethra to support it.

  • TOT: the tape is passed through small incisions in the groin.
  • TVT: the tape is passed through small incisions in the lower abdomen.

The procedure is carried out through a small vaginal incision and is quick; most patients go home the same day or the next day. Return to normal activities usually takes 2–3 weeks. Possible problems include temporary difficulty passing urine, urgency, groin pain and, rarely, exposure of the tape in the vagina.

Because future pregnancy and childbirth can cause the problem to recur, surgery is generally recommended once childbearing is complete.

Frequently asked questions

Is surgery essential for incontinence?

No. For mild and moderate symptoms, exercises and lifestyle changes are often enough. Surgery is recommended for stress incontinence that persists despite these measures.

Is sling surgery painful?

It is performed under anaesthesia. Afterwards there may be mild groin pain for a few days, controlled with painkillers.

Does surgery cure urge incontinence?

Sling surgery does not cure urge incontinence. For this type, medication, bladder training and, if needed, other advanced treatments are used.

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Prof. Dr. Derya Sivri Aydın sees patients at Medical Park Bahçelievler Hospital, Istanbul. International patients are supported by the hospital's International Patient Services Center.

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The information on this page is for general guidance only; the right diagnosis and treatment for you are decided after a consultation. Last updated: November 2026.

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