Objectives: Evaluation of botulinum toxin A (BoNT-A) transperineal intraprostatic injection in patients with lower urinary tract symptoms secondary to benign prostate hyperplasia and failed to respond to 6-m medical treatment in comparison to transurethral prostatectomy (TURP).
Patients & Methods: 92 males were divided into TURP and IP groups after being evaluated using the International Prostate Symptom Score (IPSS) and International Index of Erectile Function, estimation of serum total prostate specific antigen (tPSA), US estimation of prostatic volume (PV) and uroflowmetry determination of voiding volume (VV), maximum flow rate (Qmax) and postvoid residual (PVR) volume. BoNT-A (200 U diluted in 3 ml saline) was injected using 22-G spinal needle under TRUS guidance, 1-ml in each lobe. Patients were assessed 3-monthly for 12-m.
Results: IPSS significantly decreased in all patients with non-significant difference between both groups. Mean VV and Qmax were increased, while PVR volume, PV and serum tPSA significantly decreased. Patients showed deterioration at 12-m were re-evaluated and underwent TURP. IP injection significantly maintained erectile function than TURP.
Conclusion: BoNT-A injection reduced PV with subsequent increase in VV and Qmax and decreased PVR volume and serum PSA. IP injection allowed surgery-sparing in >70% and preserved erectile function in 91.3% of patients.
Keywords: Botulinum toxin A, Intraprostatic injection, TURP, Outcome, urodynamic studies, Erectile function
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