title: Botulinum neurotoxin A for male lower urinary tract symptoms.
abstract: OBJECTIVE
  Lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) affects a large number of male patients from 45 years onward, increasing with age. Routine medical treatment is mainly limited to plant extracts, α-blockers, and 5-α-reductase inhibitors. Although all types of drug have a proven efficacy, they often do not sufficiently treat all aspects of LUTS related to BPH. Thus, there is a need for alternatives. Intraprostatic injections with botulinum neurotoxin type A (BoNT/A) seem to be a promising alternative. The purpose of this review is to summarize the most recent findings from basic science and clinical studies in relation to BoNT/A application in BPH-related LUTS, thereby providing insight into the putative mechanism of action, the rationale for the use of BoNT/A in BPH-related LUTS, and the clinical outcomes.
  
  
  RESULTS
  There is some evidence that BoNT/A intraprostatic injections affect both, the static and dynamic component of BPH-related LUTS by reducing the prostate volume and by downregulation of α-1A-adrenoreceptors. Clinical trials demonstrated an easy and minimally invasive intraprostatic application of BoNT/A with a favourable safety profile. Efficacy seems to be good with significant improvements for several months in symptoms, urinary flow rate and reduction in postvoid residual, prostate volume, and also prostate-specific antigen in some studies.
  
  
  CONCLUSIONS
  BoNT/A seems to be a promising alternative in the treatment of BPH-related LUTS with a good tolerance and safety profile. However, the level of evidence is still low and further randomized controlled studies are mandatory.
authors.affiliation: Department of Urology, Pitié-Salpêtrière Hospital, Pierre et Marie Curie Medical School, Paris VI University, Paris. emmanuel.chartier-kastler@psl.aphp.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mehnert
authors.forename: Pierre
authors.initials: P
authors.lastname: Denys
authors.forename: Francois
authors.initials: F
authors.lastname: Giuliano
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007267:Injections; D008297:Male; D011470:Prostatic Hyperplasia / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000188:drug therapy* / Q000209:etiology
chemical_list: D019274:Botulinum Toxins, Type A