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Patient Reported Outcomes Due to Bladder Neck Obstruction in Women Treated With Botulinum Toxin A Injection.

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Botulinum toxin A injections effectively treated bladder neck obstruction (BNO) in women, improving pelvic pain and voiding symptoms. Many patients with small fiber neuropathy experienced significant relief and would repeat the procedure.

Keywords:
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Area of Science:

  • Urology
  • Neurology
  • Pelvic Health

Background:

  • Primary bladder neck obstruction (BNO) causes urinary symptoms due to the bladder neck failing to open during voiding.
  • Potential causes include neurogenic dysregulation, sympathetic nervous system issues, and increased sympathetic tone from stress.
  • Botulinum toxin A (BoNT-A) is used for BNO in women unresponsive to conventional therapies.

Purpose of the Study:

  • To evaluate patient-reported outcomes after BoNT-A treatment for BNO in women with pelvic pain.
  • To assess the efficacy of BoNT-A in improving pain and voiding dysfunction associated with BNO.

Main Methods:

  • Retrospective study of 18 female patients with BNO and pelvic pain treated with BoNT-A.
  • Diagnosis of BNO confirmed by Nitti Criteria and video urodynamics.
  • Outcomes measured via Global Response Assessment (GRA), Visual Analogue Scale (VAS) for pain, and symptom checklists.

Main Results:

  • 14 out of 17 patients (77%) reported improvement via GRA.
  • Significant improvement in incomplete emptying, hesitancy, burning, painful urination, and pelvic pain.
  • All 6 patients with biopsy-confirmed small fiber neuropathy (SFN) showed significant improvement (VAS 8.7).

Conclusions:

  • BoNT-A injections to the bladder neck offer significant improvement for pelvic pain and hesitancy in women with BNO.
  • Treatment is particularly effective in patients with co-existing small fiber neuropathy.
  • While symptom flares occur, patient interest in repeat treatments remains high.