Objectives This study aims to determine the clinical outcomes of bladder neck injection of Onabotulinumtoxin A as treatment for adult men and women with primary bladder neck obstruction (PBNO).

Methods Patients at participating institutions who underwent bladder neck injection of Onabotulinumtoxin A for PBNO between May 2011 and May 2018 were included in this retrospective case series study. All patients underwent cystoscopy to exclude anatomical causes and had video urodynamics to diagnose PBNO. Clinico-pathological data were collected from medical records. The primary outcome was subjective improvement in symptoms on clinical follow-up. Proportions were compared using Fisher’s exact test.

Results This study had 13 patients with a median age of 40. There were five men and eight women. Nine patients had failed alpha-blocker therapy previously, and none had undergone prior surgery for PBNO. Of the 12 patients who attended at least one follow-up appointment, 75% reported improvement in symptoms. The response rate was significantly higher in men compared with women (100% vs 57.1%, p=0.034). There were no significant complications reported on follow-up. We have subsequently developed a novel practical management algorithm from our clinical experience.

Conclusions Bladder neck injection of Onabotulinumtoxin A for the treatment of PBNO has a good response rate with minimal risk of complications and is a reasonable alternative or precursor to bladder neck incision surgery for patients wishing to avoid complications associated with surgery. Further prospective comparative studies on its use are warranted.

This study follows up six women from a 2018 study examining the experience of women living with pelvic surgical mesh complications. Qualitative research relating to women’s experience of treatment for mesh complications is limited. Participants had subsequently undergone surgical and non-surgical interventions for their complications. The aim of the current study was to understand the lived experience of these interventions and establish the impact of these interventions on participants’ quality of life and wellbeing.

Hermeneutic phenomenology was used with thematic analysis linking findings back to Van Manen’s four lifeworld existentials used in the 2018 study – lived space, lived body, lived time and lived other. Participants completed a repeat International Consultation on Incontinence Modular Questionnaire Lower Urinary Tract quality of life (ICIQ-LUTSqol) questionnaire and following this were interviewed via Zoom using a semi-structured approach. During the interview participants self-rated their movement across recovery trajectories. Findings were compared between the 2018 study and the 2022 follow-up.

Comparison of the women’s 2018 and 2022 overall ICIQ-LUTSqol scores approached but did not reach statistical significance. However, most participants described some areas of improvement and improved quality of life after surgical and/or non-surgical intervention for mesh complications. These interventions, along with interactions with key health stakeholders, continue to have significant impacts, both positive and negative, on women’s lived space, body, time, relationships and recoveries.

Pelvic organ prolapse affects up to 50% of women throughout life. Management can be conservative or surgical. Pessaries have become an integral component to management of pelvic organ prolapse, providing symptom improvement and enhancing quality of life. After careful clinical assessment, women choosing pessary management are offered either self-care or clinician-based pessary care. Pessary care can be offered by a range of clinicians, including doctors, nurses and physiotherapists. In this article we review the literature on the historical use of pessaries and how they have changed to be the device manufactured today. We then outline the Australian regulation of vaginal pessaries as per the Therapeutic Goods Administration (TGA). We discuss device classification in relation to clinical practice and guidelines.

The TGA classifies pessary devices as either Class 1: device which is intended for transient use, Class 2A: to be used continuously for at least 60 minutes but not more than 30 days, and Class 2B: continuous use for more than 30 days. The majority of pessaries available in Australia are classified as 2A devices.

The TGA classification of pessaries and commonly accepted standards of care in many Australian centres are not always synergistic. In Australia, varied models of care are offered for pessary management. Recent literature has identified a need for clinician guidelines and training for pessary care. The TGA device classification should be considered in Australian training and guidelines. Information on TGA device classification needs to be discussed with each patient that is offered pessary management. If 2A pessaries are used in conjunction with clinical led care, it is unlikely that the device will be removed every 30 days. Therefore, 2A devices may be used off-label and the patient should be informed of this deviation from the regulation.