Intraprostatic botulinum toxin type A injection for the treatment of benign prostatic hyperplasia: Initial experience with Dysport™

Abstract

Objective. To evaluate the effect of intraprostatic botulinum toxin type A (BoNTA, Dysport™) injection on lower urinary tract symptoms, prostate-specific antigen (PSA), prostate volume (PV), peak urine flow rate (Q_max) and postvoiding residue (PVR), and to evaluate the role of PV in the treatment outcome. Material and methods. Seventy-two men with PSA < 4 ng/ml, International Prostate Symptom Score (IPSS) ≥ 8, Q_max < 12 ml/s and PV < 60 ml were enrolled. A total of 300–600 U Dysport was injected transperineally under transrectal ultrasound guidance. Initial IPSS, quality of life (QoL) score, Q_max and PVR were compared with their measures at 1, 6 and 12 months after the injection. Initial PSA and PV were compared with their values after 6 months. Parameters were also compared between patients with PV ≤ 30 ml and those with PV > 30 ml. Results. The mean age of participants was 63.5 years. At follow-up sessions, IPSS and QoL score were significantly decreased (p < 0.001). PVR reduced significantly and Q_max increased considerably (p < 0.001). PSA and PV substantially decreased after 6 months (p < 0.001). No serious complications were reported. Similar to patients with larger prostates, IPSS and QoL score decreased statistically significantly after 12 months in those with PV ≤ 30 ml; however, changes in PV, PSA, PVR and Q_max did not persist during 12 months' follow-up. Conclusions. The procedure is safe and efficacious and the results are comparable to previous experiences with Botox^®. It seems that the toxin efficacy depends directly on PV in prostates < 60 ml.

Key Words::

• Botulinum toxin type A
• Dysport
• Iran
• lower urinary tract symptoms
• prostatic hyperplasia

Acknowledgements

Our special thanks go to the administrative staff of the Urology Research Center for their rigorous collaboration during the study. We are also grateful to Dr Laleh Montaser-Kouhsari and Dr Nima Baradaran for their priceless assistance in reviewing the manuscript. This study was supported in part by a grant from the Tehran University of Medical Sciences (no. 5381).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.