Pre-operative Polyethylene Glycol 3350 for Minimally Invasive Urogynecologic Surgery

Study Overview
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Brief Summary
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The goal of this clinical trial is to test the use of a laxative before surgery in women having surgery to fix pelvic prolapse that do not have constipation. The main question it aims to answer is: Does use of a laxative before surgery lessen the discomfort of bowel movements after surgery? Participants will be asked to complete questionnaires before and after surgery. Researchers will compare using the laxative before and after surgery versus only after surgery to see if there is less discomfort with bowel movements after surgery.

Detailed Description
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The purpose of this study is to evaluate if there is a difference in bother related to constipation between a pre-operative versus post-operative start of a bowel regimen for patients undergoing surgery for pelvic organ prolapse This will be a multi-institution, single-blind, randomized control trial utilizing questionnaires and chart review to evaluate effect of pre-operative bowel regimen on post-operative constipation. Study team and surgeons will be blinded to group assignments, participants will not be. Participants will be randomized after consent is obtained, and at least 1 week prior to planned surgery, via computer-generated blocks in a 1:1 ratio between study group (pre-operative and post-operative use) and control group (post-operative only use) of polyethylene glycol 3350 (PEG)

Official Title
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Pre- and Post-operative Compared to Post-operative Only Polyethylene Glycol 3350 for Minimally Invasive Urogynecologic Surgery

Conditions
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Constipation, Surgical Procedure, Unspecified, Prolapse; Female

Intervention / Treatment
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* Drug: Polyethylene Glycol 3350


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients assigned female sex at birth undergoing an apical prolapse procedure including: sacrocolpopexy, sacrospinous ligament suspension, uterosacral ligament suspension, or colpocleisis. Planned urogynecologic procedure may include hysterectomy, adnexectomy, colporrhaphy, perineorrhaphy, or treatment of stress urinary incontinence. Planning to undergo primary procedure as above via minimally invasive route: vaginal or laparoscopic (including robotic-assisted). Including those that have an unplanned conversion intraoperatively of minimally invasive route to open laparotomy. Exclusion Criteria: Diagnosis of irritable bowel syndrome, inflammatory bowel disease, slow transit constipation, obstructed defecation, or symptomatic constipation at time of study screening and recruitment. (Slow transit constipation and obstructed defecation defined as per American Gastroenterological Association 2013 constipation statement. Symptomatic constipation defined as any of the following: Bristol Stool Scale score of 1 or 2, PAC-SYM score greater than 1.0, self-reported 2 or less bowel movements per week.) Current use of pharmacologic laxative agent ≥1x/week (prescription or OTC) for the treatment of constipation symptoms Allergy or intolerance to polyethylene glycol 3350 Planning to undergo surgery via laparotomy Scheduled for any concurrent non-urogynecologic procedure, ex abdominoplasty History of large bowel resection, surgical treatment of constipation, or anal sphincter surgery History of sacral neuromodulation Current or prior radiation therapy to the abdomen or pelvis Current or prior diagnosis of malignancy Unable to provide informed consent

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 89 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pre-operative<br>Participants will be instructed to take 17 grams of powder Polyethylene glycol 3350 (PEG) every day starting 3 days prior to scheduled surgery date and continue to take 17 grams of PEG every day for 7 days following the day of surgery. Participants will be allowed to titrate up or down the amount of PEG used as needed and instructed to record all doses of PEG used. | Drug: Polyethylene Glycol 3350<br>* *Polyethylene glycol 3350 (PEG) will be used within it's FDA indication and dosing for constipation. Each 17-gram dose of PEG is to be mixed in 8oz of liquid.<br>* Other names: Miralax;|
| Active Comparator: Post-operative<br>Participants will be instructed to take 17 grams of powder PEG* every day for 7 days starting the day of surgery. Participants will be allowed to titrate up or down the amount of PEG used as needed and instructed to record all doses of PEG used. | Drug: Polyethylene Glycol 3350<br>* *Polyethylene glycol 3350 (PEG) will be used within it's FDA indication and dosing for constipation. Each 17-gram dose of PEG is to be mixed in 8oz of liquid.<br>* Other names: Miralax;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PAC-SYM | Patient assessment of constipation symptoms (PAC-SYM) is a validated 12-item questionnaire with reported average score 0-4. | Pre-operative, 1 week post-operative, 2 weeks post-operative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PAC-QOL: Patient assessment of constipation quality of life measure |  | Pre-operative, 2 weeks post-operative | 
| Time to first bowel movement | after surgery in approximate hours/days | 1 week post-operative | 
| Doses of PEG used | polyethylene glycol 3350 (PEG) doses of 17 grams powder mixed in 8oz of liquid | 1 week post-operative, 2 weeks post-operative | 
| Rescue laxative use | Use of additional laxatives or enemas | 1 week post-operative, 2 weeks post-operative | 
| Satisfaction with pain after surgery | Satisfaction with pain after surgery | 1 week post-operative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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postoperative constipation, minimally invasive surgery, apical prolapse, prolapse