Abstract
ABSTRACTObjectives: To evaluate transperineal intraprostatic injection of botulinum neurotoxin A (BoNT-A) in patients with lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) who failed to respond to 6-month medical treatment compared with transurethral resection of the prostate (TURP).Patients and methods: In all, 92 men were divided into TURP and BoNT-A groups after being evaluated using the International Prostate Symptom Score (IPSS) and five-item version of the International Index of Erectile Function, estimation of serum total prostate-specific antigen (tPSA), ultrasonographic estimation of prostatic volume (PV), and uroflowmetry determination of voiding volume (VV), maximum urinary flow rate (Qmax) and post-void residual urine volume (PVR). BoNT-A (200 U diluted in 3 mL saline) was injected, using a 22-G spinal needle under transrectal ultrasonography guidance, with 1-mL in each lobe. Patients were assessed 3-monthly for 12 months.Results: The IPSS significantly decreased in all patients with a non-significant difference between the groups. The mean VV and Qmax increased, whilst PVR, PV and serum tPSA significantly decreased. Patients who showed deterioration at 12 months were re-evaluated and underwent TURP. BoNT-A injection significantly maintained erectile function compared with TURP.Conclusion: Intraprostatic BoNT-A injection reduced PV with subsequent increases in VV and Qmax, and decreases in PVR and serum tPSA level. Intraprostatic BoNT-A injection allowed surgery sparing in >70% and preserved erectile function in 91.3% of patients.Abbreviations: BoNT-A: botulinum neurotoxin A; HRQOL: health-related quality of life; IIEF-5: five-item version of the International Index of Erectile Function; PV: prostatic volume; PVR: post-void residual urine volume; Qmax: maximum urinary flow rate; tPSA: total PSA; VV: voided volume
Highlights
Bladder outlet anatomical structures in men include the bladder neck, urethral sphincter and prostate [1]
We evaluated the subjective and objective outcomes of transperineal intraprostatic botulinum neurotoxin A (BoNT-A) injection, in patients with lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) who failed to respond to medical treatment, in comparison to TURP
Improvement progressed more slowly with BoNT-A injection, as shown by the significantly higher International Prostate Symptom Score (IPSS) of patients who received injections at the 3 and 6-month follow-up visits, but the difference became non-significant at the 9- and 12-month follow-ups in comparison to patients who received TURP. In both groups of patients, the extent of improved IPSS peaked at the 9-month follow-up, with a significantly higher percentage score improvement with TURP than with BoNT-A injection (Table 2, Figure 2)
Summary
Bladder outlet anatomical structures in men include the bladder neck, urethral sphincter and prostate [1]. Surgical management of BPH is indicated in medical non-responders, presenting with advanced signs of BOO and obstructive uropathy [6]. Simple open prostatectomy was the traditional management option [7] for improving LUTS, but at the expense of considerable surgical and perioperative morbidity [8]. Invasive management of male LUTS due to BOO aim to provide equal effectiveness as standard techniques with a more favourable safety profile [9]. TURP is the ‘gold standard’ method for surgical treatment of BPH [10], but other procedures such as photoselective prostate vaporisation [11] and bipolar transurethral enucleation are effective surgical options [12]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
