BackgroundBotulinum Toxin Type-A (BoNT/A) intraprostatic injection can induce prostatic involution and improve LUTS and urinary flow in patients with Benign Prostatic Enlargement (BPE). However, the duration of these effects is unknown. The objective of this work was to determine the duration of prostate volume reduction after one single intraprostatic injection of 200U of Botulinum Toxin Type-A.MethodsThis is an extension of a 6 month study in which 21 frail elderly patients with refractory urinary retention and unfit for surgery were submitted to intraprostatic injection of BoNT/A-200U, by ultrasound guided transrectal approach. In spite of frail conditions, eleven patients could be followed during 18 months. Prostate volume, total serum PSA, maximal flow rate (Qmax), residual volume (PVR) and IPSS-QoL scores were determined at 1, 3, 6, 12 and 18 months post-treatment.ResultsMean prostate volume at baseline, 82 ± 16 ml progressively decreased from month one coming to 49 ± 9,5 ml (p = 0,003) at month six. From this moment on, prostate volume slowly recovered, becoming identical to baseline at 18 months (73 ± 16 ml, p = 0.03). Albeit non significant, serum PSA showed a 25% decrease from baseline to month 6. The 11 patients resumed spontaneous voiding at month one. Mean Qmax was 11,3 ± 1,7 ml/sec and remained unchanged during the follow-up period. PVR ranged from 55 ± 17 to 82 ± 20 ml and IPSS score from10 to 12 points.ConclusionIntraprostatic BoNT/A injection is safe and can reduce prostate volume for a period of 18 months. During this time a marked symptomatic improvement can be maintained.

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Intraprostatic injection of botulinum toxin type A was shown to be effective in decreasing symptoms of BPH in several recent studies. However, the possible impairment of sexual function caused by the neurotoxin had never been investigated. This study shows that intraprostatic administration of botulinum toxin type A neither causes deterioration of sexual function (libido, orgasm, erectile function or ejaculation), nor alteration of serum testosterone levels. OBJECTIVE • To evaluate the consequences on male sexual function of intraprostatic injection of botulinum toxin type A (BoNT/A) as a treatment for benign prostatic hyperplasia (BPH). Although BoNT/A is effective in decreasing symptoms of BPH, neuronal impairment caused by the neurotoxin might affect emission/ejaculation. These aspects have not been evaluated before. PATIENTS AND METHODS • In all, 16 sexually active men aged >60 years with BPH/benign prostatic enlargement (BPE), International Prostate Symptom Score (IPSS) ≥8 and a maximum urinary flow rate (Qmax) <15 mL/s refractory to standard medical therapy volunteered for the study. • Patients were injected transrectally, under ultrasonographic control, with 200 U of BoNT/A in the prostate. Evaluation was carried out at baseline and 1, 3 and 6 months post‐treatment. Erectile function was evaluated using the International Index of Erectile Function – Short Form (IIEF‐5) questionnaire. • Orgasmic/ejaculatory function and libido were evaluated using questions 9, 10, 11 and 12 of the IIEF – Long Form. Total testosterone, luteinizing hormone (LH), follicle‐stimulating hormone (FSH) and prolactin were also investigated. RESULTS • The mean age was 73 ± 6 years. The IIEF‐5 score was 16.5 ± 6 at baseline, 15.7 ± 6 at 1 month, 16.6 ± 6 at 3 months and 15.7 ± 5 at 6 months (differences nonsignificant). • The score for ejaculatory/orgasmic function (questions 9 and 10) remained fairly constant from baseline to the sixth month, 8.3 ± 1.9 and 8 ± 2.1 respectively. • The sexual desire score (questions 11 and 12 of the IIEF) also remained little changed from baseline (5.9 ± 1.6) to month 6 (6.1 ± 2). Total serum testosterone, LH, FSH and prolactin did not change during the study. CONCLUSIONS • Intraprostatic injection of BoNT/A in patients with BPE does not impair erectile, orgasmic or ejaculatory functions and does not change libido. • The male hormonal profile is not altered by BoNT/A injection. This facilitates the acceptance of BoNT/A as a treatment for BPH/BPE lower urinary tract symptoms (LUTS) refractory to standard medical management.

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Daphnia magna is widely used as a standard organism in ecotoxicology assays. It plays a key role in energy transfer in freshwater food webs as a primary consumer, grazing on microalgae, yeast and bacteria. Daphnids are commonly reared in the laboratory using microalgae cultures but alternative or complementary sources are important to reduce the dependency on a single food source. The role played in nature by planctomycetes as a food source for other higher trophic levels is still unknown. In this study, we aimed to evaluate the potential of Rhodopirellula rubra strain LF2 as a nutritional or a supplementary food source for D. magna and Daphnia longispina. Life-history assays were conducted with daphnids fed with R. rubra in exponential and stationary growth phases, in three concentrations. Additionally, its adequacy as a supplement to the microalga Raphidocelis subcapitata was tested. In general, both daphnids showed impairment in all the parameters evaluated, especially when fed with R. rubra. However, when daphnids were fed with the two food sources, no changes were recorded for the rate of population increase. At the tested concentrations, R. rubra was not a good alternative food source in the daphnid diet.

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