Activity Restrictions After Midurethral Sling: A Randomized Controlled Trial.

Abstract

Importance: Postoperative activity restrictions can affect patient satisfaction after midurethral sling (MUS) surgery.

Objective: The aim of the study was to assess the effect of a duration of postoperative activity restrictions on patient satisfaction and surgical outcomes after MUS surgery for stress urinary incontinence.

Study design: Women undergoing MUS surgery alone for stress urinary incontinence were enrolled in this provider-blinded, randomized clinical trial. Randomization to either 3- or 6-weeks' duration of activity restrictions was assigned. Restrictions included abstaining from lifting greater than 20 pounds, high-impact activity, or strenuous exercise. Primary outcome was patient satisfaction with surgery, using a 5-point Likert patient satisfaction scale. Satisfaction scores were analyzed in a "complete satisfaction" ("completely" satisfied only) and a "higher satisfaction" approach (both "completely" and "mostly" satisfied). Secondary outcomes included objective and subjective assessment of incontinence symptoms and activity assessment.

Results: Ninety-eight women underwent MUS surgery between July 2021 and September 2022, and 88 were randomized. Of them, 41 and 43 women with 3- and 6-week restrictions had patient satisfaction data, respectively. Baseline characteristics did not differ between groups. At the 6-month postoperative visit, overall patient satisfaction ("completely" and "mostly" satisfied) was very high at 92%. Complete satisfaction was significantly higher in the 3-week (73.2%) versus the 6-week restriction group (51.2%) (P = 0.04). "Higher satisfaction" did not reach a statically significant difference between groups (P = 0.11). Subjective urinary incontinence indices did not differ between groups.

Conclusions: Return to normal activities 3 weeks after MUS surgery resulted in significantly higher satisfaction scores at 6 months compared to a 6-week restriction without compromising subjective and objective surgical success.