performing the trans-obturator procedure through the standard vertical incision

performing the trans-obturator procedure through a new technique of 2 paramedian vertical incisions

TOT procedure will be done using silicon-coated polypropylene tape that will be inserted at the mid-urethral portion. In group 1, a classical vertical vaginal incision will be done proximal to the external urethral meatus with dissection along the axis of the urethra till the mid-urethral zone that is identified by palpating the urethral catheter balloon through the vaginal at the bladder neck, while in group 2, two paramedian incisions will be done 1cm long in the anterior vaginal wall 2 cm apart parallel to the urethra till identification of the mid-urethral portion, communication will be done between the two incisions 1 cm wide in this area creating a tunnel where the tape will be placed, this technique provides healthy tissues proximal and distal to the tape that allows more stabilization and less migration. The rest of the procedure is the same as the standard procedure of Trans-obturator outside-in tension-free technique.

to evaluate TOT migration postoperative from the middle third of the urethra by trans-labial ultrasound

to evaluate TOT migration postoperative from the middle third of the urethra by trans-labial ultrasound

to evaluate TOT migration postoperative from the middle third of the urethra by trans-labial ultrasound

to evaluate success rate in treatment of stress urinary incontinence using stress cough test and urodynamic study