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: | Tarek M. El-Karamany, Tarek Gharib, Amr Eldakhakhny, Ahmed Issam |
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Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
Urology medicine.medical_treatment 030232 urology & nephrology urologic and male genital diseases urodynamic studies 03 medical and health sciences 0302 clinical medicine Quality of life intraprostatic injection Lower urinary tract symptoms Prostate Medicine Botulinum toxin A Saline Benign Prostatic Hyperplasia Transurethral resection of the prostate 030219 obstetrics & reproductive medicine medicine.diagnostic_test business.industry Hyperplasia medicine.disease TURP medicine.anatomical_structure outcome Transrectal ultrasonography International Prostate Symptom Score erectile function business |
Zdroj: | Arab Journal of Urology |
ISSN: | 2090-598X |
Popis: | 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 (Qmax) 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 Qmax 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 Qmax, 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; Qmax: maximum urinary flow rate; tPSA: total PSA; VV: voided volume |
Databáze: | OpenAIRE |
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