Evaluating a Novel Postoperative Recovery Protocol: A Randomized Control Trial

Importance Functional concerns following urogynecologic procedures are common. Active recovery may help improve pain and pelvic floor symptoms in the postoperative period. Objectives Prescribed active recovery is safe and leads to improved healing in other surgical fields. Active recovery is relatively untested in urogynecology procedures. We created a postoperative active recovery program to mitigate bowel, bladder, and pain symptoms in the postoperative period. The objective of this study was to compare this active recovery protocol to the standard of care on pelvic floor symptoms in the immediate 12-week postoperative period. Study Design This was a randomized control trial of patients undergoing minimally invasive apical prolapse reconstructive procedures at a single academic institution. Participants were randomized to either routine postoperative restrictions or the novel active recovery protocol for the first 12 weeks postoperatively. The primary outcome was the change in pelvic floor symptoms at 12 weeks postoperatively between the control group and the intervention group as measured by the Pelvic Floor Distress Inventory questionnaire (PFDI-20). Results Seventy-two participants were enrolled, 69 were randomized, and had baseline data. The active recovery group had a larger decrease in total PFDI-20 score (−87.7±54.0 vs −72.7±52.4, P =0.294), including the urinary (−33.3±30.2 vs −26.8±29.4, P =0.413) and colorectal subscales (−18.5±18.4 vs −9.9±16.9, P =0.072). Mean postoperative PFDI-20 and urinary subscale scores for the active recovery group were all significantly lower ( P <0.05) than the routine group. Conclusions Prescribed active recovery improves pelvic floor outcomes in the immediate postoperative period, particularly bladder function.