Botox may help relieve symptoms in female patients with primary bladder neck obstruction

Pondicherry: A new study conducted by Atanu Kumar Pal and the team found that when female primary bladder neck obstruction (PBNO) patients prefer a less invasive surgery, botulinum toxin can be used as an interim therapy.

The findings of this study were published in the International Urogynecology Journal.

Medication and surgery are frequent treatments for treating primary bladder neck blockage in women. In individuals whose conservative care has failed, a less invasive procedure like a bladder neck botulinum toxin injection may be an alternative option. The subjective and objective results, patient satisfaction, and readiness to undergo repeat therapy with bladder neck botulinum toxin injection in females with PBNO are all discussed in this study.

Ten female PBNO patients treated with bladder neck botulinum toxin injections for this investigation were retrospectively analyzed. Symptom evaluation, the International Prostate Symptom Score (IPSS), and Quality of life (QoL) scores were used to quantify subjective factors. Utilizing uroflowmetry's Qmax maximum flow rate and post-void residual (PVR), objective parameters were evaluated.

The key findings of this study were as follows:

1. The pre-treatment mean IPSS, QoL score, Qmax, and PVR were 24.2 ± 5.0, 4.8 ± 0.63, 5.73 ± 3.18 ml/s, and 210 ± 66 ml, respectively.

2. Seven of the 10 patients improved subjectively (IPSS 12.9 ± 9.6, QoL2.9 ± 1.6).

3. Three patients showed objective improvement (mean Qmax 17.3 ± 2.7 ml/s, PVR 42.7 ± 7.5 ml).

4. Three patients agreed to another botulinum toxin injection.

5. Three patients who did not improve had bladder neck incisions, which resulted in symptom relief.

In conclusion, Botulinum toxin may help relieve symptoms in female patients with primary bladder neck obstruction (PBNO) and can be used as a bridge therapy for patients who have failed medical treatment. Acute urine retention, a protracted duration of symptoms, and indications of significant bladder outlet blockage on VUDS are all risk factors for therapy failure. More research is needed to determine the optimum dose and standardized the procedure.

Reference: 

Pal, A. K., Kalra, S., Dorairajan, L. N., Sreenivasan, S. K., Manikandan, R., & Aggarwal, D. (2022). Outcomes of bladder neck botulinum toxin injection for female primary bladder neck obstruction—does subjective improvement correlate with an objective assessment? In International Urogynecology Journal. Springer Science and Business Media LLC. https://doi.org/10.1007/s00192-022-05319-x