European Urology

Abstract

Objectives

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.

Methods

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 × 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.

Results

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.

Conclusion

These results are encouraging. Larger, randomized, placebo-controlled trials could be worthwhile to verify these results.

Take Home Message

This small pilot study suggested marked improvement of symptoms and modest increase in urinary flow rates and opening pressures in treating BND with BoNTA. Placebo-controlled trials and further dose ranging studies are required.