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Botulinum toxin for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia

Nature Clinical Practice Urology volume 4, pages 155–160 (2007)Cite this article

Abstract

Botulinum toxin (BTX) is the most potent biological toxin used for the treatment of urologic conditions. During the last 3 years, the use of BTX has been extended to the treatment of symptomatic benign prostatic hyperplasia, however, the actual mechanism through which BTX can reduce prostate volume and infravesical resistance is not well understood. This article reviews the main effects of BTX in prostate tissues. A critical analysis of the outcomes of patients who were studied in clinical series that used this toxin to treat lower urinary tract symptoms related to benign prostatic hyperplasia is also presented.

Key Points

  • By the age of 60 years, half of all men have histologic evidence of benign prostatic hyperplasia (BPH), and virtually all men have BPH by the age of 80 years

  • Botulinum toxin A (BTX-A) is produced by the Gram-positive, anaerobic bacillus Clostridium botulinum, and is regarded as the most potent neurotoxin known to man

  • The effects of BTX-A include inhibition of acetylcholine release at the cholinergic neuromuscular junction and the neuroglandular junction, inhibition of norepinephrine release, and interference with nociception

  • Secretion from and growth of prostate epithelium are under parasympathetic control, so inhibition of parasympathetic neurotransmission with intraprostatic BTX-A injection could be an attractive option for the management of BPH

  • Preliminary studies have shown that intraprostatic injections of BTX-A could be an effective treatment for LUTS due to BPH, with minimal or no side effects; however, most published studies have been small, poorly controlled, and have had limited follow-up

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Authors and Affiliations

  1. and an Assistant Professor in the Division of Urology at University of São Paulo Medical School. M Srougi is Professor of Urology in the Department of Surgery, and Chairman of the Division of Urology at the Clinical Hospital of University of São Paulo Medical School. RF Coelho is a Resident in Urology in the Division of Urology, Division of Urology, AA Antunes is a Staff Member at the Clinical Hospital of University of São Paulo Medical School, University of São Paulo Medical School, University of São Paulo Medical School. G de Campos Freire is a Staff Member at the Clinical Hospital of University of São Paulo Medical School and Chief of the Prostate Section, University of São Paulo Medical School, São Paulo, Brazil.,

    Alberto A Antunes, Miguel Srougi, Rafael F Coelho & Geraldo de Campos Freire

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  1. Alberto A Antunes
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  2. Miguel Srougi
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  3. Rafael F Coelho
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  4. Geraldo de Campos Freire
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Correspondence to Miguel Srougi.

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The authors declare no competing financial interests.

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Antunes, A., Srougi, M., Coelho, R. et al. Botulinum toxin for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Nat Rev Urol 4, 155–160 (2007). https://doi.org/10.1038/ncpuro0735

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