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Transurethral intraprostatic Botulinum toxin-A injection: a novel treatment for BPH refractory to current medical therapy in poor surgical candidates

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Abstract

Purpose

Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in elderly men. Some patients respond poorly to routine medical therapy and are not well suited for surgery, too. This study was planned to evaluate the effect of Botulinum-A on BPH refractory to current medical therapy in poor surgical candidates.

Methods

In this clinical trial, 10 patients with LUTS suggestive of BPH who had responded poorly to medical therapy for at least 6 months and were poor surgical candidates, were received different doses of transurethral Botulinum-A injection based on their prostate volume. The prostate volume, PSA, Qmax, IPSS, PVR and frequency of nocturia were evaluated and compared before and after treatment.

Results

The mean IPSS was 24.50 ± 3.8 and 13.40 ± 2.67 before and after the treatment, respectively (P < 0.001). The mean prostate volume was decreased from 41.50 ± 10.85 mL to 30.40 ± 8.05 mL (P < 0.001). The Qmax was increased from 7.87 ± 2.01 mL/s to 16.19 ± 1.76 mL/s (P < 0.001). The mean PSA was 3.12 ± 0.49 ng/mL and 1.71 ± 0.39 ng/mL before and after treatment, respectively (P < 0.001). The mean PVR was 75.6 ± 51.63 mL and 63.50 ± 36.59 mL before and after treatment, respectively (P = 0.096). The mean number of nocturia was decreased from 4.1 ± 0.87 to 2.4 ± 0.84 (P < 0.001). The mean IPSS, Prostate volume, PSA and frequency of nocturia were decreased significantly. Although mean PVR was decreased but it wasn’t statistically significant. The mean Qmax was increased significantly.

Conclusion

Intraprostatic injection of Botulinum-A may be an effective and safe treatment for symptomatic BPH in selected patients whose medical treatment has faced failure and are poor surgical candidates. Transurethral method could be selected as a preferable technique of injection.

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References

  1. Walsh PC (1996) Treatment of B.P.H. N Engl J Med 335:557–563

    Google Scholar 

  2. Lepor H (1998) The pathophysiology of lower urinary tract symptoms in the ageing male population. Br J Urol 81:29–33

    PubMed  Google Scholar 

  3. McConnell JD, Bruskewitz R, Walsh P, Andriole G, Lieber M, Holtgrewe HL et al (1998) The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride long-term efficacy and safety study group. N Engl J Med 338:557–563

    Article  PubMed  CAS  Google Scholar 

  4. Lepor H, Williford WO, Barry MJ, Brawer MK, Dixon CM, Gormley G et al (1996) The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans affairs cooperative studies benign prostatic hyperplasia study group. N Engl J Med 335:533–539

    Article  PubMed  CAS  Google Scholar 

  5. Kuo HC (2005) Prostatic Botulinum A toxin injection- an alternative for benign prostatic obstruction in poor surgical candidates. Urology 65:670–674

    Article  PubMed  Google Scholar 

  6. AUA practice guidelines committee (2003) AUA guideline on management of benign prostatic hyperplasia, Chap. 1, diagnosis and treatment recommendations. J Urol 2003(170):530–547

    Google Scholar 

  7. Smith CP, Chancellor MB (2004) Emerging role of botulinium toxin in the treatment of voiding dysfunction. J Urol 171(6 Pt 1):2128–2137

    Article  PubMed  CAS  Google Scholar 

  8. Aoki KR (2001) A comparison of the safety margin of Botulinum neurotoxin serotypes A, B, and F in mice. Toxicon 39:1815

    Google Scholar 

  9. Hc Kuo (2003) Effect of Botulinium A toxin in the treatment of voiding dysfunctiom due to detrusor overactivity. Urology 61:550–554

    Article  Google Scholar 

  10. Barry MJ, Roehrborn CG (2001) Benign prostatic hyperplasia. BMJ 323:1042–1046

    Article  PubMed  CAS  Google Scholar 

  11. Andersen JT, Nickel JC, Marshall VR, Schulman CC, Boyle P (1997) Finasteride significantly reduces acute urinary retention and need for surgery in patients with symptomatic benign prostatic hyperplasia. Urology 49:839–845

    Article  PubMed  CAS  Google Scholar 

  12. Rapp DE, Turk KW, Bales GT, Cook SP (2006) Botulinum toxin type a inhibits calcitonin gene-related peptide release from isolated rat bladder. J Urol 175(3 Pt 1):1138–1142

    Article  PubMed  CAS  Google Scholar 

  13. Duggan MJ, Quinn CP, Chaddock JA, Purkiss JR, Alexander FC, Doward S et al (2002) Inhibition of release of neurotransmitters from rat dorsal root ganglia by a novel conjugate of a Clostridium Botulinum toxin A endopeptidase fragment and Erythrina cristagalli lectin. J Biol Chem 227:34846–34852

    Article  Google Scholar 

  14. Morenilla-Palao C, Planells-Cases R, García-Sanz N, Ferrer-Montiel A (2004) Regulated exocytosis contributes to protein kinase C potentiation of vanilloid receptor activity. J Biol Chem 279:25665–25672

    Article  PubMed  CAS  Google Scholar 

  15. Dinis P, Charrua A, Avelino A, Nagy I, Quintas J, Ribau U, Cruz F (2005) The distribution of sensory fibers immunoreactive for the TRPV1 (capsaicin) receptor in the human prostate. Eur Urol 48:162–167

    Article  PubMed  Google Scholar 

  16. Silva J, Silva C, Saraiva L, Silva A, Pinto R, Dinis P, Cruz F (2000) Intraprostatic Botulinum toxin type A Injection in patients unfit for surgery presenting with refractory urinary retention and benign prostatic enlargement effect on prostate volume and micturition resumption. Eur Urol 53:153–159

    Article  Google Scholar 

  17. Oeconomou A, Madersbacher H, Kiss G, Berger TJ, Melekos M, Rehder P (2008) Is Botulinum neurotoxin type A (BoNT-A) a novel therapy for lower urinary tract symptoms due to benign prostatic enlargement? A review of the literature. Eur Urol 54:765–775

    Article  PubMed  CAS  Google Scholar 

  18. Chuang YC, Huang CC, Kang HY, Chiang PH, Demiguel F, Yoshimura N, Chancellor MB (2000) Novel action of Botulinum toxin on the stromal stromal and epithelial components of the prostate gland. J Urol 175(3 Pt 1):1158–1163

    Google Scholar 

  19. Lin AT, Yang AH, Chen KK (2007) Effects of Botulinum toxin A on the contractile function of dog prostate. Eur Urol 52:582–589

    Article  PubMed  CAS  Google Scholar 

  20. Ventura S, Pennefather JN, Mitchelson F (2002) Cholinergic innervation and function in the prostate gland. Pharmacol Ther 94:93–112

    Article  PubMed  CAS  Google Scholar 

  21. Doggweiler R, Zermann DH, Ishigooka M, Schmidt RA (1998) Botox induced prostatic involution. Prostate 37:44–50

    Article  PubMed  CAS  Google Scholar 

  22. Smith CP, Franks ME, McNeil BK, Ghosh R, de Groat WC, Chancellor MB, Somogyi GT (2003) Effect of botulinum toxin A on the autonomic nervous system of the rat lower urinary tract. J Urol 169:1896–1900

    Article  PubMed  CAS  Google Scholar 

  23. Chuang YC, Chiang PH, Huang CC, Yoshimura N, Chancellor MB (2005) Botulinum toxin type A improves benign prostatic hyperplasia symptoms in patients with small prostates. Urology 66:775–779

    Article  PubMed  Google Scholar 

  24. Maria G, Brisinda G, Civello IM, Bentivoglio AR, Sganga G, Albanese A (2003) Relief by Botulinum toxin of voiding dysfunction due to benign prostatic hyperplasia: results of a randomized, placebo-controlled study. Urology 62:259–264

    Article  PubMed  Google Scholar 

  25. Guercini F, Giannantoni A, Bard RL, Brisinda G, Cadeddu F, Maria G et al (2005) Intraprostatic botulin toxin injection in patients with severe benign prostatic hyperplasia a multicenter feasibility study. J Urol 173(suppl.):376–377

    Google Scholar 

  26. Chuang YC, Chancellor MB (2006) The application of Botulinium Toxin in the prostate. J Urol 176:2375–2382

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

Authors of this article have no conflict of interest for this manuscript and do not have any financial interest.

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Authors and Affiliations

  1. Urology Research Center, Razi Hospital, Guilan University of Medical Sciences, Sardar Jangal St., Rasht, Iran

    Ali Hamidi Madani, Ahmad Enshaei, Abtin Heidarzadeh, Gholamreza Mokhtari, Alireza Farzan, Mani Mohiti Asli & Samaneh Esmaeili

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  1. Ali Hamidi Madani
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  2. Ahmad Enshaei
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  3. Abtin Heidarzadeh
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  4. Gholamreza Mokhtari
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Correspondence to Ahmad Enshaei.

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Hamidi Madani, A., Enshaei, A., Heidarzadeh, A. et al. Transurethral intraprostatic Botulinum toxin-A injection: a novel treatment for BPH refractory to current medical therapy in poor surgical candidates. World J Urol 31, 235–239 (2013). https://doi.org/10.1007/s00345-012-0851-z

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  • DOI: https://doi.org/10.1007/s00345-012-0851-z

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