Evaluation of short term clinical effects and presumptive mechanism of botulinum toxin type A as a treatment modality of benign prostatic hyperplasia.
The purpose of this study was to evaluate the effect and investigate the putative mechanism of botulinum toxin type A (BTA) applied to the treatment of benign prostatic hyperplasia (BPH). A total of 52 patients with symptomatic BPH were evaluated. Transperineal intraprostatic injection under transrectal ultrasonography was carried out. BTA dissolved in 4 to 9 mL of saline was used from 100 U to 300 U, according to prostate volume. Twenty-six patients received only BTA (BT group), and 26 received both BTA and one month of an alpha-adrenergic antagonist (BTalpha group). The therapeutic outcomes were evaluated by comparing parameters such as international prostate symptom score (IPSS), quality of life, prostate specific antigen, prostate volume, post-void residual urine, and peak urinary flow rate. At the one month follow- up, 18 patients in the BT group and 21 in the BTalpha group had subjective symptomatic relief (p = 0.337). Only IPSS5 (weak stream) was significantly different between the BT group and BTalpha groups (p = 0.034). At the three month follow-up, 39 patients had subjective symptomatic relief. The storage symptoms were improved more than the voiding symptoms. Additionally, about 50 percent of the patients whose voiding symptom improved expressed improved erectile function. BTA injection seems to be an alternative treatment for BPH. The differences after the one month evaluation between the BT and the BTalpha groups might suggest that the adrenergic influence could be relatively reinforced by the anticholinergic effect of BTA. Nitric oxide would thus be involved in a BTA action mechanism in BPH.
Park
Dong Soo
DS
Department of Urology, Bundang CHA Hospital, Pochon CHA University College of Medicine, 351 Yatap-dong, Pundang-gu, Seongnam, Kyonggi-do 463-712, Korea. dsparkmd@cha.ac.kr
Cho
Taek Woo
TW
Lee
Yong Kyu
YK
Lee
Young Tae
YT
Hong
Young Kwon
YK
Jang
Woong Ki
WK
D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D017292:Doxazosin / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000188:drug therapy*; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use; D000077409:Tamsulosin
D000317:Adrenergic alpha-Antagonists; D009465:Neuromuscular Agents; D013449:Sulfonamides; D019274:Botulinum Toxins, Type A; D000077409:Tamsulosin; D017292:Doxazosin