Intraprostatic and bladder-neck injection of botulinum A toxin in treatment of males with bladder-neck dyssynergia: a pilot study.

Abstract

To determine if intraprostatic and bladder-neck injection of botulinum toxin A (BoNTA) in patients with bladder-neck dyssynergia (BND) is a feasible alternative therapy. Males diagnosed with BND on video-urodynamics showing delayed and incomplete bladder-neck opening during voluntary voiding were recruited. Eight consenting patients had 100 U of BoNTA injected transurethrally into the bladder neck and proximal prostatic urethra laterally (10 U/ml x 10 sites). Patients were assessed at preinjection, at 1, 6, and 2 wk, and at 4 weekly intervals thereafter by means of uroflometry, 3-d frequency-volume chart, and International Prostate Symptom Score (IPSS)-Quality of life (QoL) questionnaire. Urodynamic studies were done at screening and 6 wk postprocedure. The mean age was 36.9 yr. Mean duration of symptoms was 6.5 yr. At 6 wk, 7 of 8 (87.5%) patients had>50% reduction of IPSS from baseline. Overall mean reduction was 50% (19.9+/-2.7 vs. 9.9+/-1.7, p=0.036). Six of 8 (75.0%) patients had> 3 ml/s increase in peak urinary flow rate with overall mean peak urinary flow rates improving from 11.6 to 17.2 (p=0.048) at 6 wk. Micturition frequency decreased 46% (13.6 vs. 7.6, p=0.036) and IPSS-QoL scores improved 47% (4.9+/-0.2 vs. 2.6+/-0.6, p=0.048). None reported any adverse effects or ejaculation dysfunction. Three of 8 patients had recurrence of symptoms after a mean of 8 mo. These results are encouraging. Larger, randomized, placebo-controlled trials could be worthwhile to verify these results.