Perspective of Botox for treatment of male lower urinary tract symptoms

Abstract

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) are frequently encountered in ageing men. The medical treatment for lower urinary tract symptoms/BPH is not totally effective or without side effects. The use of transurethral resection of the prostate, the 'gold standard' surgical intervention for BPH is progressively changing to minimally invasive surgical therapies. But none of them provided clear long-term results, with no complication. Thus, there has been much interest in the development of alternative treatments such as the injection of botulinum toxin type A (BTX-A) into the prostate. There are two main factors that contribute to lower urinary tract symptoms in BPH: the excessive growth (static component) and increase in smooth muscle tone (dynamic component). BTX-A seems to be the first therapeutic agent to target both factors. Its use inhibits the autonomic efferent effects on prostate growth and contraction and also inhibits the abnormal afferent effects on prostate sensation. BTX-A injected into prostate appears to be well tolerated and effective. Although the clinical series demonstrate efficacy of minimum 6 months, more studies are necessary in order to identify the mechanisms by which BTX-A affects the prostate, the ideal dose and the duration of effect. BTX-A use in prostate disease is currently 'off-label'.