Activity Restrictions After Midurethral Sling: A Randomized Controlled Trial

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

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.

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.

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.

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.