ABSTRACT
In 1990, Mouchel was the first to attempt to recreate the natural urethral supportive system with a mesh for the treatment of stress urinary incontinence. The transobturator tape (TOT) sling is held in place by friction between the tape and the musculoaponeurotic structures of the obturator foramen. Compared to RPT, the primary aim of the transobturator route was to decrease the risk of visceral (bladder, bowels), and vascular injuries. The TOT procedure published was immature and incurred various complications, which led to the development of the so-called horizontal TOT which the authors have been practising since 2003. In its medial aspect, the obturator foramen is divided into two parts by the parietal insertion of the levator ani muscle. The aim of this movement is to trace a perineal trajectory with the surgical instrument whilst remaining underneath the superior fascia of the levator ani muscle.
