Botulinum toxin in high-risk BPH patients in retention

This is a prospective study evaluating the efficacy of botulinum toxin A injection in benign prostatic hyperplasia (BPH) patients. Twenty-one men with benign prostatic enlargement on chronic indwelling catheter for at least 3 months who were not candidates for surgery because of poor general condition received 200 U botulinum toxin A in the transition zone by transrectal approach under ultrasound guidance. This was done as an outpatient procedure without any anesthesia. Mean patient age was 80 ± 2 years. No significant local effects occurred. Patients were reevaluated at 1 and 3 months post-treatment. Baseline prostate volume of 70 ± 10 ml decreased to 57 ± 10 ml at 1 month and to 47 ± 7 ml at 3 months. At 1 month, 16 patients (76%) could resume voiding with a mean Qmax OF 9.0 ± 1.2 ml/s. At 3 months, 17 patients (81%) voided with a mean Qmax of 10.3 ± 1.4 ml/s. Residual urine was 80 ± 19 ml and 92 ± 24 ml at 1 and 3 months, respectively. Mean serum total PSA decreased from 6.0 ± 1.1 ng/ml at baseline to 5.0 ± 0.9 ng/ml at 3 months. The authors conclude that botulinum A injection into the prostate swiftly reduces prostate volume and may be a promising treatment for refractory urinary retention in patients with benign prostatic enlargement who are unfit for surgery.