Comment on “Activity Restrictions After Midurethral Sling: A Randomized Controlled Trial”

Recent shifts in surgical fields have reflected an earlier return to normal activity after procedures, as studies have shown improved outcomes. Evidence within urogynecology suggests similar patterns, though there is great variation in postoperative recommendations after pelvic floor or gynecologic surgery, and particularly in midurethral sling (MUS) procedures for stress urinary incontinence (SUI). This study was designed to evaluate the effects of the length of activity restriction after MUS surgery on patient satisfaction and urinary outcomes after 6 months. This was a single-center, 2-arm, single-blinded randomized controlled trial conducted at Yale University. Inclusion criteria were women undergoing MUS surgery for SUI over the age of 18 and ambulatory. Exclusion criteria were concurrent procedures and unwillingness or inability to complete associated questionnaires. Each participant was randomized to either a short (3-wk) period of activity restrictions or a long (6-wk) period of activity restrictions. Restrictions included avoiding heavy lifting and other strenuous activities such as running, aerobic exercise, and high-impact activities for this period. All were instructed to avoid swimming, bathing, and sexual activity for 6 weeks. Questionnaires used to assess patient symptoms and satisfaction include the Urinary Distress Inventory (UDI) Long Form, the Incontinence Impact Questionnaire—Short Form (IIQ-7), and the Activity Assessment Scale (AAS), as well as the Patient Global Impression of Improvement (PGI-I) and a 5-point satisfaction questionnaire. The primary outcome for this study was patient satisfaction at 6 months after surgery. The final enrollment consisted of 88 participants, with 44 randomized to each group. The final analysis included data from 41 patients in the short restriction group and 43 patients in the long restriction group. Baseline SUI symptoms were not significantly different between groups, nor were baseline activity levels. At 6 months postoperatively, the short activity restriction group reported significantly higher rates of satisfaction ( P = 0.04). Both groups had significantly improved symptoms and quality of life at 6 months postsurgery, and no significant differences were reported between groups. These results indicate that shorter postoperative activity restrictions increased patient satisfaction and did not detect a decrease in the effectiveness of the surgery in improving SUI symptoms and quality of life. This adds evidence to the growing body of research showing that shorter periods of postoperative activity restrictions for pelvic and gynecologic surgery can increase satisfaction without increasing the risk of complications. Though this is likely the first randomized controlled trial focusing on MUS surgeries, other studies have found similar results in other pelvic surgeries. There is a lack of consensus on postoperative activity restrictions, and this evidence can contribute to future evidence-based guidelines. Future research should validate these findings as well as assess more long-term outcomes, such as surgical effectiveness over time. (Summarized from Alvarez P, Demirkiran C, Rickey L, et al. Activity restrictions after midurethral sling: a randomized controlled trial. Urogynecology (Phila). 2026;32:58-64. doi: 10.1097/SPV.0000000000001679)