Intraprostatic injection of botulinum toxin type-A relieves bladder outlet obstruction in human and induces prostate apoptosis in dogs.
BACKGROUND
With the increasing interest with botulinum toxin--A (BTX-A) application in the lower urinary tract, we investigated the BTX-A effects on the canine prostate and also in men with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH).


METHODS
Transperineal injection into the prostate using transrectal ultrasound (TRUS) was performed throughout the study. Saline with or without 100 U of BTX-A was injected into mongrel dogs prostate. One or 3 months later, the prostate was harvested for morphologic and apoptotic study. In addition, eight BPH patients refractory to alpha-blockers were treated with ultrasound guided intraprostatic injection of 200 U of BTX-A.


RESULTS
In the BTX-A treated dogs, atrophy and diffuse apoptosis was observed with H&E stain and TUNEL stain at 1 and 3 months. Clinically, the mean prostate volume, symptom score, and quality of life index were significantly reduced by 18.8%, 73.1%, and 61.5% respectively. Maximal flow rate significantly increased by 72.0%.


CONCLUSIONS
Intraprostatic BTX-A injection induces prostate apotosis in dogs and relieves BOO in humans. It is therefore a promising alternative treatment for refractory BOO due to BPH.
Chuang
Yao-Chi
YC
Department of Urology, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan. chancellormb@Upmc.edu
Tu
Chieh-Hsien
CH
Huang
Chao-Cheng
CC
Lin
Hsin-Ju
HJ
Chiang
Po-Hui
PH
Yoshimura
Naoki
N
Chancellor
Michael B
MB
D000368:Aged; D000818:Animals; D017209:Apoptosis; D001284:Atrophy; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004285:Dogs; D006801:Humans; D020287:In Situ Nick-End Labeling; D007267:Injections; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011467:Prostate / Q000187:drug effects* / Q000473:pathology; D011470:Prostatic Hyperplasia / Q000150:complications; D018084:Ultrasonography, Interventional; D001748:Urinary Bladder Neck Obstruction / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A