Urodynamic Effects of Transrectal Intraprostatic Ona botulinum Toxin A Injections for Symptomatic Benign Prostatic Hyperplasia

Kort, Laetitia M.O. de; Kok, Esther T.; Jonges, Trudy N.; Bosch, J.L.H. Ruud

doi:10.1016/j.urology.2012.06.004

Cited by 21 publications

(17 citation statements)

References 25 publications

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“…The influence of BoNT-A on the dynamic component and sensory afferent nerves are of therapeutic importance and might be responsible for this positive finding. Kort et al 73 reported results that further support the heterogeneous response to BoNT-A treatment. These investigators enrolled 15 patients with an IPSS >7, a prostate volume of 30-50 cm 3 , and a urodynamic BOO of Schäfer grade >2 to their study.…”

Section: Mechanism Of Actionmentioning

confidence: 89%

“…However, the studies have shown no consistency in clinical response in terms of outcome parameters such as symptom scores (for example, the American Urological Association Symptom Index [AUASI] and the International Prostate Symptom Score [IPSS]), reduction in prostate volume, postvoid residual urine volume, peak urinary flow rate (Q max ) and PSA (Table 1). [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79] One intriguing finding is the observation that, even without a relevant impact on prostate volume in selected patients, the application of BoNT-A resulted in an increase in peak urinary flow rate and amelioration of LUTS. 65 This observation highlights the various pathophysiological aspects underlying LUTS suggestive of BPH.…”

Section: Mechanism Of Actionmentioning

confidence: 99%

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New intraprostatic injectables and prostatic urethral lift for male LUTS

2015

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Treatment modalities for male lower urinary tract symptoms (LUTS) comprise a broad spectrum of medical and surgical options. Interest is growing in minimally invasive treatment options, which should ideally be performed in an outpatient setting and have a short recovery time, durable efficacy and a good safety profile. The preservation of all aspects of sexual function, including antegrade ejaculation, seems to be increasingly important for patients. Initial experimental data on new minimally invasive procedures-such as the intraprostatic injection of novel agents including botulinum neurotoxin A (BoNT-A), NX-1207 and PRX302-were promising, but clinical trials have not confirmed the findings. Trials of the mechanical prostatic urethral lift device-Urolift(®) (Neotract, Inc., USA)-have been positive, but further long-term results are needed to confirm its beneficial effects.

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Section: Mechanism Of Actionmentioning

confidence: 89%

Section: Mechanism Of Actionmentioning

confidence: 99%

New intraprostatic injectables and prostatic urethral lift for male LUTS

2015

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“…63 Results of these pilot studies seem promising, although other studies have not consistently shown the same results. 64,65 Furthermore, results of a randomized, double blind, placebo controlled phase II trial, published in 2013, failed to indicate any significant improvements in either urinary symptom scores or prostate measures in patients with LUTS and BPH who were treated with either BoNTA or placebo. 12 The pathophysiology of LUTS in men is often multi factorial.…”

Section: Bph and Male Lutsmentioning

confidence: 99%

Current and potential urological applications of botulinum toxin A

Jiang

Liao

2015

Nat Rev Urol

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Botulinum toxin subtype A (BoNT-A) is a potent neurotoxin that can selectively modulate neurotransmitter release from nerve endings, resulting in muscular paralysis. BoNT-A might also act on sensory nerves, and have an anti-inflammatory effect. In the first urological use of BoNT-A, injection into the urethral sphincters of patients with detrusor-sphincter dyssynergia resulted in a reduction of urethral resistance and improved voiding efficiency. Subsequently, intravesical BoNT-A injections have received regulatory approval for treatment of neurogenic detrusor overactivity owing to spinal cord lesions or multiple sclerosis, and idiopathic overactive bladder in adults. BoNT-A has also been widely used to treat patients with the off-label indications of neurogenic or non-neurogenic voiding dysfunction and male lower urinary tract symptoms owing to BPH and bladder-neck dysfunction. Other indications for which urologists have applied BoNT-A injections include interstitial cystitis/bladder pain syndrome, bladder oversensitivity and chronic pelvic pain syndrome. BoNT-A is currently delivered as an intravesical injection; however, use of liposome encapsulated formulations is also beginning to show some therapeutic potential.

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“…Animal studies showed that intraprostatic BoNT-A injections can induce selective denervation and subsequent apoptosis and atrophy of the prostate gland [52]. Prostatic injections of BoNT-A can be performed using transperineal, transrectal or transurethral routes [53][54][55]. Published studies on Botox reported that 200 U of Botox reconstituted with normal saline to a volume of 20% of the total prostate volume is required for the injections into the transition zone and peripheral zone of the prostate gland and to avoid any penetration into the bladder [53].…”

Section: Benign Prostatic Hyperplasiamentioning

confidence: 99%

“…Published studies on Botox reported that 200 U of Botox reconstituted with normal saline to a volume of 20% of the total prostate volume is required for the injections into the transition zone and peripheral zone of the prostate gland and to avoid any penetration into the bladder [53]. Common adverse events such as hematuria, difficult urination, perineal pain and acute prostatis, is likely related to inadvertent penetration of the injection needles into the prostatic urethra and bladder neck [53][54][55].…”

Section: Benign Prostatic Hyperplasiamentioning

confidence: 99%

Botulinum toxin in urology: a review of clinical potential in the treatment of urologic and sexual conditions

Chung

2014

Expert Opinion on Biological Therapy

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BoNT-A has received regulatory approval for use in neurogenic DO and overactive bladder, but its use remains unlicensed in other lower urinary tract conditions such as non-neurogenic lower urinary tract symptoms in men with benign prostatic hyperplasia, bladder pain syndrome and DSD. Published literature shows that BoNT can be effective in carefully selected patient groups, has minimal adverse event profile and is generally well tolerated by many patients. However, many questions remain unanswered and larger scale multi-institutional studies are required to determine the key factors in BoNT treatment success.

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Urodynamic Effects of Transrectal Intraprostatic Ona botulinum Toxin A Injections for Symptomatic Benign Prostatic Hyperplasia

Cited by 21 publications

References 25 publications

New intraprostatic injectables and prostatic urethral lift for male LUTS

New intraprostatic injectables and prostatic urethral lift for male LUTS

Current and potential urological applications of botulinum toxin A

Botulinum toxin in urology: a review of clinical potential in the treatment of urologic and sexual conditions

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