Transurethral intraprostatic Botulinum toxin-A injection: a novel treatment for BPH refractory to current medical therapy in poor surgical candidates

Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in elderly men. Some patients respond poorly to routine medical therapy and are not well suited for surgery, too. This study was planned to evaluate the effect of Botulinum-A on BPH refractory to current medical therapy in poor surgical candidates. In this clinical trial, 10 patients with LUTS suggestive of BPH who had responded poorly to medical therapy for at least 6 months and were poor surgical candidates, were received different doses of transurethral Botulinum-A injection based on their prostate volume. The prostate volume, PSA, Qmax, IPSS, PVR and frequency of nocturia were evaluated and compared before and after treatment. The mean IPSS was 24.50 +/- A 3.8 and 13.40 +/- A 2.67 before and after the treatment, respectively (P < 0.001). The mean prostate volume was decreased from 41.50 +/- A 10.85 mL to 30.40 +/- A 8.05 mL (P < 0.001). The Qmax was increased from 7.87 +/- A 2.01 mL/s to 16.19 +/- A 1.76 mL/s (P < 0.001). The mean PSA was 3.12 +/- A 0.49 ng/mL and 1.71 +/- A 0.39 ng/mL before and after treatment, respectively (P < 0.001). The mean PVR was 75.6 +/- A 51.63 mL and 63.50 +/- A 36.59 mL before and after treatment, respectively (P = 0.096). The mean number of nocturia was decreased from 4.1 +/- A 0.87 to 2.4 +/- A 0.84 (P < 0.001). The mean IPSS, Prostate volume, PSA and frequency of nocturia were decreased significantly. Although mean PVR was decreased but it wasn't statistically significant. The mean Qmax was increased significantly. Intraprostatic injection of Botulinum-A may be an effective and safe treatment for symptomatic BPH in selected patients whose medical treatment has faced failure and are poor surgical candidates. Transurethral method could be selected as a preferable technique of injection.