Prostatic Injection of Botulinum A Toxin: An Alternative Treatment for Benign Prostatic Hyperplasia
DOI:
https://doi.org/10.22100/jkh.v4i1.179Keywords:
Prostate, Botulinum A toxin, Benign prostatic hyperplasia (BPH).Abstract
Introduction: We examined the clinical effectiveness of prostate injection of botulinum A toxin in the treatment of BPH.
Methods: In this descriptive study, 55 men with BPH, who had failed medical treatment and were poor risks for surgery, were treated by injection of botulinum A toxin into different parts of the transition zone. Amounts of prostate-specific antigen(PSA), prostate symptom scores, quality-of-life index, prostate volume, postvoid residual urine volume, and peak urinary flow rates were recorded and compared for all patients before injection and 3 and 6 months after the injection.
Results: The mean patient age was 78±2.5 years. The mean symptom score and quality-of-life index significantly improved after 3 months. Maximal urinary flow rate (Qmax) showed a significant increase after 3 and 6 months of treatment. Postvoid residual urine volume had a significant decrease after 3 and 6 months (P<0.05). Mean serum total PSA decreased from 5.1±1.5 ng/ml to 2.7±0.9 ng/ml within 3 months after the treatment (P>0.05). Prostate volume decreased from 65±8 ml to 59±6 ml within 1 month and to 49±5 ml within 3 months (P<0.05). The maximal treatment effect was seen after 1 week. At the end of the 6- month follow up, 48 patients had improved symptoms and in 32 patients, medical treatments were discontinued. Only in 7 patients, symptoms were remaining.
Conclusion: The study showed that prostatic injection of botulinum A toxin (BTX-A) leads to rapid reduction of prostate volume as well as reduction in urethral resistance in patients with bladder outlet obstruction due to enlargement of prostate and it can be regarded as a treatment for resistant urinary retention in patients with benign prostatic hyperplasia who are poor risks for surgery. This alternative treatment has the minimal side effects. It may even be considered as an adjuvant treatment in patients with prostate cancer.
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