There is a growing body of evidence suggesting that strict postoperative restrictions may
not be beneficial. Emerging data indicate that these restrictions do not significantly
influence short- or long-term outcomes and may even have detrimental effects, such as
increasing the incidence of venous thromboembolism and overall deconditioning.
Due to limited data on optimal postoperative restrictions following midurethral sling
surgery, providers struggle to offer consistent, evidence-based recommendations. This
variability can lead to inconsistent patient counseling, underscoring the need for
further research to support or challenge universal postoperative restrictions.
Recent studies indicate that limited postoperative restrictions following pelvic organ
prolapse surgery do not result in inferior outcomes. O'Shea et al. found that expedited
activity post-surgery did not negatively affect anatomic or symptomatic results.
Similarly, Mueller et al. reported that patients who resumed preoperative activities
experienced fewer prolapse and urinary symptoms, with no inferior short-term anatomical
outcomes. Arunachalam et al. also demonstrated that specific postoperative instructions
did not significantly influence physical activity levels.
The latest guidelines for mesh hernia repair, the most common general surgery procedure
involving synthetic mesh, recommend that patients resume activities without restriction
post-surgery. Previous concerns that increased intra-abdominal pressure might lead to
sling migration or mesh incorporation have not been substantiated. Studies show that
abdominal pressures during daily activities overlap with those during physical exertion,
and since patients cannot avoid daily activities like coughing or transitioning from
sitting to standing, there is no physiological basis for strict restrictions.
While recent literature supports the safety of limited postoperative restrictions after
pelvic prolapse surgery, this has not been validated for mid-urethral sling procedures.
Traditionally, patients are advised to reduce activity for six to eight weeks
post-surgery, which may deter physically active individuals from opting for the
procedure. Given that the mid-urethral sling is considered the gold standard for treating
stress urinary incontinence, relaxing restrictions and allowing quicker return to
baseline activity could encourage more individuals to undergo this surgery.
Secondary Aims
Compare incidence of adverse events, including mesh exposure, in each group
Compare self-reported activity levels between groups
Compare post-operative pain scores at 2 weeks and 3 months postoperatively
Compare incidence of new onset dyspareunia