Intraprostatic and bladder-neck injection of botulinum A toxin in treatment of males with bladder-neck dyssynergia: a pilot study.
OBJECTIVE
To determine if intraprostatic and bladder-neck injection of botulinum toxin A (BoNTA) in patients with bladder-neck dyssynergia (BND) is a feasible alternative therapy.


METHODS
Males diagnosed with BND on video-urodynamics showing delayed and incomplete bladder-neck opening during voluntary voiding were recruited. Eight consenting patients had 100 U of BoNTA injected transurethrally into the bladder neck and proximal prostatic urethra laterally (10 U/ml x 10 sites). Patients were assessed at preinjection, at 1, 6, and 2 wk, and at 4 weekly intervals thereafter by means of uroflometry, 3-d frequency-volume chart, and International Prostate Symptom Score (IPSS)-Quality of life (QoL) questionnaire. Urodynamic studies were done at screening and 6 wk postprocedure.


RESULTS
The mean age was 36.9 yr. Mean duration of symptoms was 6.5 yr. At 6 wk, 7 of 8 (87.5%) patients had>50% reduction of IPSS from baseline. Overall mean reduction was 50% (19.9+/-2.7 vs. 9.9+/-1.7, p=0.036). Six of 8 (75.0%) patients had> 3 ml/s increase in peak urinary flow rate with overall mean peak urinary flow rates improving from 11.6 to 17.2 (p=0.048) at 6 wk. Micturition frequency decreased 46% (13.6 vs. 7.6, p=0.036) and IPSS-QoL scores improved 47% (4.9+/-0.2 vs. 2.6+/-0.6, p=0.048). None reported any adverse effects or ejaculation dysfunction. Three of 8 patients had recurrence of symptoms after a mean of 8 mo.


CONCLUSIONS
These results are encouraging. Larger, randomized, placebo-controlled trials could be worthwhile to verify these results.
Lim
Sey Kiat
SK
Department of Urology, Changi General Hospital, Singapore. smurferoos@hotmail.com
Quek
Pearllyn L C
PL
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003558:Cystoscopy; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections / Q000379:methods; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D010865:Pilot Projects; D011446:Prospective Studies; D011467:Prostate; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder; D001748:Urinary Bladder Neck Obstruction / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D014554:Urination / Q000187:drug effects; D014563:Urodynamics / Q000187:drug effects
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A