Intraprostatic Botox injection in patients with severe benign prostatic hyperplasia.

INTRODUCTION & OBJECTIVES: Botulinum toxin (BTX-A) blocks acetylcholine release at the neuromuscular junction and in autonomic neurons. It has been widely used to treat patients with dystania, pelvic floor disorders, and gustatory or axillary sweating. In patients with voiding dysfnnction, weakening of the urethral sphincter muscle by BTX injection is followed by symptoms improvement. BTX-A injection into the rat prostate induces selective denervation and subsequent atrophy. Recently, inta'aprostatic BTX-A has been reported to be efficacious in men with moderate voiding obstruction mad medium sized prostates. Given this background, the present study was designed to determine the effects of BTX-A intraprostatie injection in patients with severe benign prostatic hyperplasia (BPH). MATERIAL & METHODS: 16 Patients were recruited to the study which was approved by the Perugia University Ethics Committee. Inclusion criteria were prostatic volume >80cc and urinary peak flow ranging from 10 to 0 ml/sec (with indwelling catheters). The only exclusion criterion was presence of neurogenic bladder disorders. Patients underwent DRE, TRUS with uroflowetry and PSAt evaluation. Symptoms were assessed by the AUA -IPSS score. Each patient received an intraprostatic ultrasound-guided injection of 150 U of BTX-A in a saline solution into each lobe. Patients underwent the same baseline evaluations after 1, 2 and 6 months' follow-up. Data were analysed using the maalysis ofvarimace for repeated measures. RESULTS: The mean age of patients was 68.8 years (range: 56-90). All patients had BPH except for one who had low grade adenocarcinoma (not considered in PSAt evaluation). At the beginning of the treatment 3 patients had indwelling catheters.CONCLUSIONS: We consider intraprostatic BTX-A injection as a mutually exclusive alternative to surgery in high grade voiding dysfunction for BPH or cancer, particularly in patients at risk.