To estimate response to intravesical onabotulinumtoxinA (BoNT-A) injection and platelet-rich plasma (PRP) therapy in females with bladder pain syndrome (BPS) without Hunner lesions, we developed and internally validated treatment-specific predictive models integrating clinical characteristics, bladder functional parameters, and urinary biomarkers.
Females with BPS who underwent intravesical BoNT-A injection or PRP therapy were retrospectively analyzed. A total of 273 female patients were included in the final analysis. Multivariable logistic regression models were constructed to predict treatment response, defined as a Global Response Assessment score ≥ 2. Model discrimination was assessed using the area under the receiver operating characteristic (ROC) curve. For interpretability, nomogram visualizations and a conceptual framework are provided in the Supporting Information.
The BoNT-A model demonstrated acceptable discrimination (area under the ROC curve: 0.789), whereas the PRP model showed superior discriminatory performance (area under the ROC curve: 0.895). Distinct clinical features and biomarker patterns contributed to each treatment-specific model, suggesting differential underlying mechanisms. Internal validation revealed higher observed response rates when the administered therapy matched the model-predicted higher probability of response, supporting internal model concordance.
Treatment-specific models combining clinical, urodynamic, and urinary biomarker data provide mechanistic insight into heterogeneous response profiles to BoNT-A and PRP in females with BPS. While these models may inform future phenotype-guided research and prospective validation, external validation is required before broader clinical implementation.
Lower urinary tract symptoms. 2026 Mar [Epub]
Wan-Ru Yu, Tsung-Cheng Hsieh, Ya-Hui Wu, Hann-Chorng Kuo
Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan., Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan., Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan.