Botulinum toxin shows sustained, positive effects in BPH

Intraprostatic injection of botulinum toxin type A (Botox) is a safe and effective treatment in patients with symptomatic BPH that results in improvements in symptoms and quality of life that may persist for up to 1 year, researchers from Taiwan said.

Yao-Chi Chuang, MD, of Chang Gung Memorial Hospital, Kaohsiung Medical Center, reported outcomes for 41 men treated with botulinum toxin type A. All were refractory to medication and had received no previous invasive therapy for their BPH.

Twenty-one men with a prostate volume less than 30 mL received a dose of 100 U; 20 men with larger prostates received a dose of 200 U. The injections were delivered via a transperineal approach under transrectal ultrasound guidance.

The treatment was safe and well tolerated, with no patients developing any significant local or systemic side effects attributable to the botulinum toxin. Thirty-one (76%) of the 41 men achieved more than a 30% improvement in both IPSS and QOL scores. Mean prostate volume also decreased significantly by about 15% in both dosage groups. While 12 men had no change of prostate volume, maximal flow rate still improved by more than 30% among seven (58%) of those patients. In addition, four of five men (80%) in urinary retention for more than 1 month were able to void spontaneously between 1 week and 1 month after the botulinum toxin injection.

"Further studies including a placebo-controlled arm and histological and molecular evaluation are needed to confirm the beneficial effect of botulinum toxin type A treatment for symptomatic BPH and to evaluate its mechanism," Dr. Chuang said.