title: Intraprostatic botulinum toxin type a injection in patients unfit for surgery presenting with refractory urinary retention and benign prostatic enlargement. Effect on prostate volume and micturition resumption.
abstract: OBJECTIVE
  To evaluate the effect of intraprostatic injection of botulinum toxin A (BoNTA) on prostate volume and refractory urinary retention in patients with benign prostatic enlargement.
  
  
  METHODS
  Twenty-one men with benign prostatic enlargement on chronic indwelling catheter for at least 3 mo who were not candidates for surgery because of poor general condition received 200 U BoNTA in the transition zone by transrectal approach under ultrasound guidance. Patients were reevaluated at 1 and 3 mo posttreatment.
  
  
  RESULTS
  Patients had a mean age of 80+/-2 yr. Injections were done without anaesthetic support as an outpatient procedure. No significant local effects occurred. Baseline prostate volume of 70+/-10 ml decreased to 57+/-10 ml (p<0.0006) at 1 mo and to 47+/-7 ml (p=0.03 against 1 mo) at 3 mo. At 1 mo, 16 patients (76%) could resume voiding with a mean Qmax of 9.0+/-1.2 ml/s. At 3 mo, 17 patients (81%) voided with a mean Qmax of 10.3+/-1.4 ml/s. Residual urine was 80+/-19 ml and 92+/-24 ml at the two time points, respectively. Mean serum total PSA decreased from 6.0+/-1.1 ng/ml at baseline to 5.0+/-0.9 ng/ml at 3 mo (p=0.04).
  
  
  CONCLUSIONS
  BoNTA injection into the prostate swiftly reduces prostate volume and may be a promising treatment for refractory urinary retention in patients with benign prostatic enlargement who are unfit for surgery. Future studies will determine the duration of BoNTA effect.
authors.affiliation: Department of Urology, Hospital de S. João, and Faculty of Medicine of Porto University, Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Silva
authors.forename: Carlos
authors.initials: C
authors.lastname: Silva
authors.forename: Luis
authors.initials: L
authors.lastname: Saraiva
authors.forename: André
authors.initials: A
authors.lastname: Silva
authors.forename: Rui
authors.initials: R
authors.lastname: Pinto
authors.forename: Paulo
authors.initials: P
authors.lastname: Dinis
authors.forename: Francisco
authors.initials: F
authors.lastname: Cruz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D000075202:Contraindications; D018450:Disease Progression; D019160:Endosonography; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011467:Prostate / Q000000981:diagnostic imaging* / Q000187:drug effects; D011468:Prostatectomy; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D016896:Treatment Outcome; D016055:Urinary Retention / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014554:Urination / Q000187:drug effects / Q000502:physiology