Botulinum Toxin Injections Effective for BPH

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GLASGOW—Intraprostatic injections of botulinum neurotoxin type A (BoNT-A) are a safe and effective treatment for benign prostatic hyperplasia (BPH), according to a study.

The treatment results in significant improvements in International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual (PVR), researchers reported at the International Continence Society annual meeting.

Researchers at Military Hospital Dr. Carlos Arvelo in Caracas, Venezuela, and the University of Sao Paulo in Brazil studied the effects of two BoNT-A doses in 36 BPH patients with lower urinary tract symptoms and who had failed previous medical treatment with an alpha-adrenergic antagonist. The investigators randomly assigned the men to receive 100 IU or 200 IU intraprostatic injections under local anesthesia. The total BoNT-A dose was diluted in 1 mL saline. Each subject received five injections, including two in each lateral lobe and one in the median lobe of the prostate. The primary outcome was the change in IPSS after six months.

Two patients, one from each group, missed follow-up evaluations and were excluded from analysis, leaving 34 patients in the study.

From baseline to six months post-treatment, the mean IPSS decreased from 22 to 7.5 in the 100 IU group and from 22.8 to 9.2 in the 200 IU group. Mean Qmax increased from 8.6 to 10.9 mL/sec in the 100 IU group and from 7.0 to 11.4 mL/sec in the 200 IU group. Mean PVR decreased from 131.8 to 38.5 mL in the 100 IU group and from 121.1 to 51.7 mL in the 200 IU group. The effects of the treatment on IPSS, Qmax, and PVR were similar in both groups. Prostate volume decreased significantly only in the 200 IU group six months after treatment (from 43.1 mL at baseline to 37.8 mL at six months).

The researchers observed early complications in six patients (17.4%), including hematuria, prostatitis, and urinary retention. These were managed successfully with conservative treatment.

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