title: Botulinum toxin type A improves benign prostatic hyperplasia symptoms in patients with small prostates.
abstract: OBJECTIVE
  To expand the clinical use of botulinum toxin A (BTX-A) in treating patients with small prostates and symptomatic benign prostatic hyperplasia (BPH). BTX-A injection into the prostate in patients with voiding dysfunction and large prostates has been reported.
  
  
  METHODS
  Sixteen men with symptomatic BPH, a prostate volume less than 30 cm3, peak flow rate less than 12 mL/s, and with refractory disease after at least 1 month of alpha-blocker treatment received BTX-A 100 U injection into the prostate transperineally under transrectal ultrasound guidance. The clinical effects were evaluated at baseline and after treatment.
  
  
  RESULTS
  No significant local or systemic side effects were observed in any of the patients. All patients reported subjective improvement starting at approximately 1 week and achieved a maximal effect after 1 month that was maintained at 3 and 6 months. At 6 to 12 months (mean 10) of follow-up, no patient had symptom recurrence. The mean prostate volume, symptom score, and quality-of-life index were significantly reduced by 13.3% (from 19.6 +/- 1.2 to 17.0 +/- 1.1 cm3), 52.6% (from 18.8 +/- 1.6 to 8.9 +/- 1.9), and 44.7% (from 3.8 +/- 0.3 to 2.1 +/- 0.3), respectively. The maximal flow rate increased significantly by 39.8% (from 7.3 +/- 0.7 to 11.8 +/- 0.8 mL/s). In 2 patients who underwent biopsy 1 month after BTX-A injection, terminal deoxynucleotidyl-mediated deoxyuridine triphosphate nick end labeling staining demonstrated an increase in apoptotic activity, not only in the glandular component, but also in the stromal component of the prostatic tissue.
  
  
  CONCLUSIONS
  BTX-A injected into the prostate is a promising treatment for patients with small prostates and symptomatic BPH.
authors.affiliation: Division of Urology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Yao-Chi
authors.initials: YC
authors.lastname: Chuang
authors.forename: Po-Hui
authors.initials: PH
authors.lastname: Chiang
authors.forename: Chao-Cheng
authors.initials: CC
authors.lastname: Huang
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Michael B
authors.initials: MB
authors.lastname: Chancellor
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009498:Neurotoxins / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000188:drug therapy*
chemical_list: D009498:Neurotoxins; D019274:Botulinum Toxins, Type A