title: Urodynamic effects of transrectal intraprostatic Ona botulinum toxin A injections for symptomatic benign prostatic hyperplasia.
abstract: OBJECTIVE
  To investigate urodynamic, symptomatic, and histologic effects of intraprostatic injection with Ona botulinum toxin A for benign prostatic hyperplasia.
  
  
  METHODS
  Patients >55 years with symptomatic benign prostatic hyperplasia failing medical therapy were treated. Inclusion criteria were International Prostate Symptom Score >7, prostate volume 30-50 cm(3), and urodynamic bladder outlet obstruction >Schäfer grade 2. A transrectal intraprostatic injection of 200 IU Ona botulinum toxin A was given. Filling cystometry and pressure flow studies were performed at 3, 6, and 12 months post injection. International Prostate Symptom Score, International Prostate Symptom Score quality of life, prostate-specific antigen, and prostate volume were measured up until 12 months; prostate biopsies before and after Ona botulinum toxin A injection were done for histology and cell proliferation.
  
  
  RESULTS
  Fifteen men (mean age 64.9 years) were included. Ona botulinum toxin A injection was well tolerated with few complications. Postvoid residual improved (170 to 80 mL), but maximum flow rate and bladder outlet resistance parameters did not change during follow-up. International Prostate Symptom Score and International Prostate Symptom Score quality of life improved (22 to 13 and 5 to 2, respectively), whereas prostate-specific antigen and prostate volume remained unaltered. Cell proliferation did not decrease and in 37% and 64% of pre- and posttreatment biopsies, respectively, some degree of prostatitis was found. Ten of 15 patients eventually underwent transurethral prostate resection because of persisting symptoms.
  
  
  CONCLUSIONS
  Intraprostatic Ona botulinum toxin A for symptomatic benign prostatic hyperplasia did not affect urodynamic outcomes, except for postvoid residual. Although symptom scores improved, we were not able to show change in prostate volume, prostate-specific antigen, or histologic outcomes. A placebo effect of intraprostatic Ona botulinum toxin A could not be ruled out.
authors.affiliation: Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands. l.m.o.dekort@umcutrecht.nl
authors.forename: Laetitia M O
authors.initials: LM
authors.lastname: de Kort
authors.forename: Esther T
authors.initials: ET
authors.lastname: Kok
authors.forename: Trudy N
authors.initials: TN
authors.lastname: Jonges
authors.forename: Peter F W M
authors.initials: PF
authors.lastname: Rosier
authors.forename: J L H Ruud
authors.initials: JL
authors.lastname: Bosch
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D009929:Organ Size / Q000187:drug effects; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood / Q000187:drug effects; D011470:Prostatic Hyperplasia / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D053448:Prostatism / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D018709:Statistics, Nonparametric; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology; D014563:Urodynamics / Q000187:drug effects*
chemical_list: D009465:Neuromuscular Agents; D017430:Prostate-Specific Antigen; D019274:Botulinum Toxins, Type A