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IMACTIV: A Pilot Study of the IMpact of Unrestricted ACTIVity Following Urethral Sling Surgery - Beyond the Abstract

Women undergoing surgical treatment of stress urinary incontinence are seeking improvement in physical functioning and quality of life. In fact, an increase in physical activity levels has been shown in women after mid-urethral sling (MUS) surgery1. In our experience, patients are often eager to return to unrestricted activity as soon as they are cleared by their physicians. However, it is still standard of care in many centers to recommend several weeks of lifting and exercise restrictions after MUS surgery.


There is growing evidence that exercise restrictions may not be necessary after many minimally invasive procedures. The most recent literature on mesh hernia repairs indicates that permitting patients to return to their usual activities immediately after surgery, including unrestricted exercise and weightlifting, does not lead to inferior outcomes2-4. Additionally, when women undergoing pelvic reconstructive surgery were randomized to liberal compared with restricted postoperative recommendations, the two groups had similar satisfaction scores and the liberal group reported fewer prolapse and urinary restrictions than the restricted group5.

In our randomized pilot study, we found no difference in continence outcomes for women with traditional versus limited activity restrictions following MUS surgery, suggesting that activity restrictions after MUS surgery may be unnecessary. There were differences in health-related quality of life in the early post-operative period, but these differences were not sustained.

Written by: Lauren N Tholemeier, Eunice Choi, Catherine Bresee, Colby P Souders, Falisha F Kanji, Jennifer T Anger, Karyn S Eilber

Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA., Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA., Biostatistics Core at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA., Department of Urology, UT Southwestern Medical Center., Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA., Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA., Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.


References:

  1. Sung VW, Kassis N, Raker CA. Improvements in physical activity and functioning after undergoing midurethral sling procedure for urinary incontinence. Obstet Gynecol. 2012;120(3):573-580.
  2. Tolver MA, Rosenberg J, Bisgaard T. Convalescence after laparoscopic inguinal hernia repair: a qualitative systematic review. Surg Endosc. 2016;30(12):5165-5172.
  3. Pommergaard HC, Burcharth J, Danielsen A, et al. No consensus on restrictions on physical activity to prevent incisional hernias after surgery. Hernia. 2014;18(4):495-500.
  4. HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165.
  5. Mueller MG, Lewicky-Gaupp C, Collins SA, et al. Activity Restriction Recommendations and Outcomes After Reconstructive Pelvic Surgery: A Randomized Controlled Trial. Obstet Gynecol. 2017;129(4):608-614.
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