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Outcomes of bladder neck botulinum toxin injection for female primary bladder neck obstruction—does subjective improvement correlate with an objective assessment?

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Abstract

Introduction and hypothesis

Common options for management of primary bladder neck obstruction (PBNO) in women include medications and surgical treatment. Less invasive treatment such as bladder neck botulinum toxin injection can be an alternate therapy in patients with failed conservative management. In this study, we describe the subjective and objective outcomes, patient satisfaction, and willingness for repeat treatment with bladder neck botulinum toxin injection in females with PBNO.

Methods

A retrospective analysis of ten female PBNO patients managed with bladder neck botulinum toxin injection was performed. Subjective parameters were quantified with symptom assessment, International Prostate Symptom Score (IPSS), and Quality of life (QoL) score. Objective parameters were assessed with maximum flow rate (Qmax) in uroflowmetry and postvoid residual (PVR).

Results

The mean pre-treatment IPSS, QoL score, Qmax, PVR was 24.2 ± 5.0, 4.8 ± 0.63, 5.73 ± 3.18 ml/s, and 210 ± 66 ml, respectively. Seven of the ten patients subjectively improved (IPSS 12.9 ± 9.6, QoL2.9 ± 1.6, p < 0.05). Three patients improved objectively (mean Qmax 17.3 ± 2.7 ml/s, PVR 42.7 ± 7.5 ml, p < 0.05). Three patients accepted repeat botulinum toxin injection. Three patients who showed no improvement underwent bladder neck incision with resolution of symptoms.

Conclusion

Botulinum toxin can be an intermediary therapy in female patients with PBNO who want a minimally invasive procedure.

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Authors and Affiliations

  1. Department of Urology & Renal Transplantation, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), An Institute of National Importance, Govt. of India, Jipmer Campus Road, Gorimedu, Puducherry, 605006, Pondicherry, India

    Atanu Kumar Pal, Sidhartha Kalra, Lalgudi Narayanan Dorairajan, Sreerag Kodakkattil Sreenivasan, Ramanitharan Manikandan & Deepanshu Aggarwal

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  1. Atanu Kumar Pal
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  2. Sidhartha Kalra
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Contributions

Atanu Kumar Pal: Data Collection, Manuscript writing.

Sidhartha Kalra: Concept, Project development, Intervention, Final drafting, Final editing and approval.

Lalgudi Naryanan Dorairajan: Final editing and approval.

Sreerag Kodakkattil Sreenivasan: Project development, Review of the manuscript.

Ramanitharan Manikandan: Final editing and approval.

Deepanshu Aggarwal: Manuscript writing, Editing.

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Correspondence to Sidhartha Kalra.

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Pal, A.K., Kalra, S., Dorairajan, L.N. et al. Outcomes of bladder neck botulinum toxin injection for female primary bladder neck obstruction—does subjective improvement correlate with an objective assessment?. Int Urogynecol J 34, 1049–1054 (2023). https://doi.org/10.1007/s00192-022-05319-x

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