Long-Term Physical Activity Levels and Physical Functioning Outcomes After Midurethral Sling

Urinary incontinence (UI) affects approximately 15.7% of women and can impact physical activity (PA), often due to a fear of urinary leakage. Studies have reported >60% of women with daily urine leakage reporting a diminished physical functioning (PF), and this is especially predominant in women with stress urinary incontinence (SUI) in their fifth or sixth decades of life. Midurethral sling (MUS) is a surgical intervention for SUI that has demonstrated significant improvements in PF at 6 months postoperation. This long-term follow-up study of a previously published prospective study of women undergoing outpatient MUS aimed to determine the effect of MUS on improving leisure PA levels and PF in women 60 months or more after MUS surgery for SUI. This study included English-speaking women younger than 70 years old undergoing MUS for symptomatic SUI with a prespecified treatment goal of improving PA or PF. Participants completed questionnaires for incontinence, PA, and PF at baseline, 6 months, 12 months, and 60 months or more postoperatively. The primary study outcome was leisure PA level, and improvement was defined as a change from sedentary level to moderate or sufficient level or change from moderate level to sufficient level 60 months or more after MUS. Preoperative PA and PF levels were compared with the 60 month or more outcomes. Secondary outcomes examined included NIH Patient-Reported Outcomes Measurement Information System measures of PF score, Body Image Scale score, and urinary symptoms severity using the Pelvic Floor A total of 85 women completed the primary study, with 35 participants completing the >60-month follow-up surveys for this follow-up study. Thirty-two patients had data that could be analyzed, with a follow-up range of 5.8 to 8 years (median, 6.8 years) and baseline mean age of 49.8 years. At follow-up of 60 or more months, 1 participant had undergone retreatment of SUI, 8 participants developed limitations unrelated to incontinence that prevented exercise, and 1 participant had unresolved SUI with new mixed UI. Of the 22 participants with no SUI retreatment or new exercise limitations, 16 (72.7%) reported improvement or maintained their level of PA. Preoperatively, 31.3% of patients had sedentary, 12.5% had moderate, and 56.3% had sufficient leisure PA levels. At 60 months or more follow-up, 21.9% had sedentary, 12.5% had moderate, and 65.6% had sufficient leisure PA levels. Of participants with baseline sedentary or moderate PA levels (n = 14), 8 (57.1%) improved their leisure PA levels and 5 (35.7%) who could have improved maintained the same level of overall PA at follow-up. Significant improvement was seen when comparing preoperative and 60-month follow-up median scores in Pelvic Floor Distress Inventory 20 (63.0 vs 12.5), Pelvic Floor Impact Questionnaire Short Form 7 (33.3 vs 0), and Body Image Scale scores (7 vs 3) (all P's < 0.001). A modest improvement in leisure PA level and significant improvement in PF were observed at 60 months postoperatively in women that underwent MUS procedure for SUI with a self-reported goal of improving physical function. Although these data are limited by small sample size, there are existing data supporting even small improvements in PA as seen here that may have significant effects on health.