eP489 - OnabotulinumtoxinA Levator Ani Injections for Male Pelvic Floor Tension Myalgia

Purpose/Background: Studies reviewing treatment options for male patients with pelvic floor tension myalgia (PFTM) remain limited, with the majority published in urology literature focused on treatments of sexual dysfunction and scrotal pain. We present a case series of three male patients presenting with pelvic floor spams, anal pain, and pain with defecation.Methods/Interventions: A pelvic floor physical therapist evaluated each patient, identifying resting hypertonicity of the levator ani complex. Following neuromuscular reeducation with electromyography/biofeedback, each patient had persistent increased resting baseline tone. An elective onabotulinumtoxinA (BTA) injection was performed in the operating room. Each procedure was performed using 200 units reconstituted with 6ml saline, divided into six tuberculin syringes, each with a 23 gauge, 1.5-inch needle. These were injected into the bilateral levator ani complex using a transperineal approach. A visual analog scale (VAS) pain assessment was obtained from the patients at each pre-operative visit and four weeks following injection. If needed, a subsequent injection was performed no sooner than eight weeks from the initial injection.Results/Outcomes: The VAS contained four Likert scale questions rated 0 (no pain) to 10 (worst pain). Two patients had a 2-point increase in their typical/average pain at four weeks from injection (the third patient had no documented change in average pain). Both patients developed anal fissures during their post-operative timeframe. None of the patients had an increase in their pain at its worst, and all noted a decrease in the percentage of waking hours with their pain at its worst. All patients experienced a 1–2-point reduction in their pain level at its best and noted an increase in the percentage of awake hours that their pain was at its best. Two of the three patients elected to undergo subsequent injection procedures as their pain had returned to baseline at 12 weeks.Conclusion/

Discussion: OnabotulinumtoxinA has shown consistent results when used for female PFTM. Few studies review or quantify benefits in male patients in quantities large enough to guide practice. Early results in our series indicate promising therapeutic use of BTA in male patients with PFTM. More studies are needed to determine the optimal concentrations, dose variation, and injection intervals for male patients with PFTM.