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Grand Rounds

Is Pelvic Muscle Strengthening Effective Following Pelvic Surgery for Prolapse and Incontinence?

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BACKGROUND AND PURPOSE:

  • Perioperative behavioral therapy with pelvic floor muscle training (BPMT) has been used in patients recovering from transvaginal reconstructive surgery for prolapse
  • Weidner et al. (Physical Therapy 2017) evaluated the effect of perioperative BPMT on health-related quality of life (HRQOL) and sexual function following vaginal surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI)

METHODS:

  • Secondary report of the OPTIMAL study
  • OPTIMAL trial was a multicenter RCT of women with stage 2-4 POP and SUI using double (2×2) randomization
    • Sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) were compared
    • Perioperative BPMT versus usual care were compared
  • Data collection: Pelvic Floor Impact Questionnaire (PFIQ) short-form subscale, 36-item Short-Form Health Survey (SF-36), Pelvic Organ Prolapse-Urinary Incontinence Sexual Questionnaire short form (PISQ-12), Patient Global Impression of Improvement (PGII), and Brink scores

RESULTS:

  • Data was collected from 137 BPMT participants and 146 of usual care participants at 24 months
  • There were no statistically significant differences between groups in PFIQ, SF- 36, PGII, PISQ-12, or body image scale measures

CONCLUSION:

  • Authors recognize the following limitations
    • Findings may not apply to vaginal prolapse procedures not addressed in this study
    • There were differing levels in BPMT expertise
  • The use of perioperative BPMT following vaginal surgery for POP and SUI provided no additional improvement in HRQOL or sexual function

Learn More – Primary Sources:

Perioperative Behavioral Therapy and Pelvic Muscle Strengthening Do Not Enhance Quality of Life After Pelvic Surgery: Secondary Report of a Randomized Controlled Trial.

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Related ObG Topics:

Practical info for your gynecology practice
Surgery for Urinary Incontinence – When the Sling’s the Thing
Mesh and Pelvic Organ Prolapse: ACOG Practice Advisory & ACOG/AUGS Recommendations 
Midurethral Tape and Repeat Surgery for Stress Incontinence: Is the 2nd Time the Charm?
Urinary Incontinence – How to Make the Diagnosis in Your Office and When to Refer

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