{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:24:09Z","timestamp":1786119849756,"version":"build-2736575974"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Primary bladder neck obstruction (BNO) occurs when the bladder neck fails to open during voiding. The cause of BNO is not fully understood but may be related to smooth muscle hypertrophy, increased collagen deposition, or sympathetically mediated high\u2010tone smooth muscle of the urethra. As there is symptom overlap with other urinary pathology, diagnosis is challenging, and there are limited treatments with a paucity of data. Onabotulinum toxin A (BoNT\u2010A) to the bladder neck has shown improvement in symptoms caused by BNO in women in a small retrospective study. We aimed to prospectively analyze the therapeutic efficacy of BoNT\u2010A to the bladder neck as a treatment option for women with BNO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We performed a pilot study recruiting female patients with pelvic pain and BNO from September 2023 to July 2024. Patients were diagnosed with BNO using the urodynamic Nitti Criteria, patient symptoms of hesitancy, straining, and\/or dysuria, and cystoscopic evidence suggesting BNO. Patients were assessed prior to BoNT\u2010A injection to the bladder neck and 4\u20106 weeks post\u2010procedure. The procedure consisted of 100 units of BoNT\u2010A reconstituted to 2\u2009mL of Marcaine or saline with 0.5\u2009mL injected cystoscopically at 10, 2, 5, and 7 o'clock in the bladder neck. The primary outcome was the change in the Female Genitourinary Pain Index Scale (Female GUPI, scores range from 0 to 44, lower scores are better). Secondary outcomes pre\u2010procedure versus post\u2010procedure included the Pelvic Floor Distress Index\u201020 (PFDI\u201020, scores range from 0 to 300, lower scores are better), a pain visual analogue scale (VAS, ranging from 0\u2010no pain to 10\u2010worst pain), and post\u2010void residual (PVR) volumes. The Global Response Assessment (GRA, \u22123 to +3, +3 better) was included post\u2010procedure. Data were analyzed using descriptive statistics, and outcomes were compared using the Wilcoxon signed\u2010rank test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010two female patients with BNO were recruited to our study. Patients had significant improvement in the Female GUPI with a decrease in scores from a median of 34.5 (IQR 31\u221236) pre\u2010bladder neck BoNT\u2010A to 26 (20.3\u201029.8) post\u2010procedure (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). The Pain, Urination, and Quality of Life subscales of the Female GUPI all demonstrated significant improvement (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Median improvement on the GRA was 1.4 (SD 1.4). Compared to baseline, there was improvement in the Urinary Distress Index\u20106 (UDI\u20106) subscale (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012) but not in overall PFDI\u201020 total scores, which includes prolapse and bowel symptoms in addition to the UDI\u20106 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.161). The median PVR prior to treatment was 126\u2009mL (IQR 50\u2212193), and after treatment decreased to 28 (14\u221259) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>BNO in women encounters limited therapeutic options. BoNT\u2010A to the bladder neck may be considered. BoNT\u2010A to the bladder neck demonstrated improvement in pain, lower urinary tract symptoms (LUTS), and PVR volumes in those with refractory BNO.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.70240","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T09:43:34Z","timestamp":1771407814000},"page":"466-471","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Onabotulinum Toxin A Is a Viable Intervention for Bladder Neck Obstruction in Women: A Prospective Pilot Study of Patient Reported Outcomes"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7029-2200","authenticated-orcid":false,"given":"Brittany Lee","family":"Roberts","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Albany Medical Center Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darrell","family":"Bibicheff","sequence":"additional","affiliation":[{"name":"Albany Medical College Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise J. B.","family":"De","sequence":"additional","affiliation":[{"name":"Department of Urology Albany Medical Center Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"issue":"8","key":"e_1_2_12_2_1","first-page":"S12","article-title":"Primary Bladder Neck Obstruction in Men and Women","volume":"7","author":"Nitti V. W.","year":"2005","journal-title":"Reviews in Urology"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.22178"},{"issue":"2","key":"e_1_2_12_4_1","first-page":"53","article-title":"Primary Bladder Neck Obstruction","volume":"21","author":"Sussman R. D.","year":"2019","journal-title":"Reviews in Urology"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(01)67037-X"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24858"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2021.10.006"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)68101-3"},{"key":"e_1_2_12_9_1","first-page":"41","article-title":"The Long\u2010Term Effects of Transurethral Bladder Neck Incision in the Treatmentof Female Bladder Neck Obstruction","volume":"1","author":"Qin Y.","year":"2022","journal-title":"Urology Journal"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000280271"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-022-05319-x"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.25626"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)68947-1"},{"issue":"4","key":"e_1_2_12_14_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/S0022-5347(09)60031-8","article-title":"Validation of a Genitourinary Pain Index for Use in Men and Women","volume":"181","author":"Clemens J. 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