Transperineal intraprostatic injection of botulinum neurotoxin A vs transurethral resection of prostate for management of lower urinary tract symptoms secondary to benign prostate hyperplasia: A prospective randomised study.

Autor: El-Dakhakhny AS; Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt., Gharib T; Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt., Issam A; Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt., El-Karamany TM; Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt.
Jazyk: angličtina
Zdroj: Arab journal of urology [Arab J Urol] 2019 Oct 03; Vol. 17 (4), pp. 270-278. Date of Electronic Publication: 2019 Oct 03 (Print Publication: 2019).
DOI: 10.1080/2090598X.2019.1662214
Abstrakt: Objectives : To evaluate transperineal intraprostatic injection of botulinum neurotoxin A (BoNT-A) in patients with lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) who failed to respond to 6-month medical treatment compared with transurethral resection of the prostate (TURP). Patients and methods : In all, 92 men were divided into TURP and BoNT-A groups after being evaluated using the International Prostate Symptom Score (IPSS) and five-item version of the International Index of Erectile Function, estimation of serum total prostate-specific antigen (tPSA), ultrasonographic estimation of prostatic volume (PV), and uroflowmetry determination of voiding volume (VV), maximum urinary flow rate (Q max ) and post-void residual urine volume (PVR). BoNT-A (200 U diluted in 3 mL saline) was injected, using a 22-G spinal needle under transrectal ultrasonography guidance, with 1-mL in each lobe. Patients were assessed 3-monthly for 12 months. Results : The IPSS significantly decreased in all patients with a non-significant difference between the groups. The mean VV and Q max increased, whilst PVR, PV and serum tPSA significantly decreased. Patients who showed deterioration at 12 months were re-evaluated and underwent TURP. BoNT-A injection significantly maintained erectile function compared with TURP. Conclusion : Intraprostatic BoNT-A injection reduced PV with subsequent increases in VV and Q max , and decreases in PVR and serum tPSA level. Intraprostatic BoNT-A injection allowed surgery sparing in >70% and preserved erectile function in 91.3% of patients. Abbreviations: BoNT-A: botulinum neurotoxin A; HRQOL: health-related quality of life; IIEF-5: five-item version of the International Index of Erectile Function; PV: prostatic volume; PVR: post-void residual urine volume; Q max : maximum urinary flow rate; tPSA: total PSA; VV: voided volume.
(© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)
Databáze: MEDLINE
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