Silva João, Pinto Rui, Carvalho Tiago, Botelho Francisco, Silva Pedro, Oliveira Rui, Silva Carlos, Cruz Francisco, Dinis Paulo
Department of Urology, Hospital S, João, Porto, Portugal.
BMC Urol. 2009 Aug 15;9:9. doi: 10.1186/1471-2490-9-9.
Botulinum Toxin Type-A (BoNT/A) intraprostatic injection can induce prostatic involution and improve LUTS and urinary flow in patients with Benign Prostatic Enlargement (BPE). However, the duration of these effects is unknown. The objective of this work was to determine the duration of prostate volume reduction after one single intraprostatic injection of 200U of Botulinum Toxin Type-A.
This is an extension of a 6 month study in which 21 frail elderly patients with refractory urinary retention and unfit for surgery were submitted to intraprostatic injection of BoNT/A-200U, by ultrasound guided transrectal approach. In spite of frail conditions, eleven patients could be followed during 18 months. Prostate volume, total serum PSA, maximal flow rate (Qmax), residual volume (PVR) and IPSS-QoL scores were determined at 1, 3, 6, 12 and 18 months post-treatment.
Mean prostate volume at baseline, 82 +/- 16 ml progressively decreased from month one coming to 49 +/- 9,5 ml (p = 0,003) at month six. From this moment on, prostate volume slowly recovered, becoming identical to baseline at 18 months (73 +/- 16 ml, p = 0.03). Albeit non significant, serum PSA showed a 25% decrease from baseline to month 6. The 11 patients resumed spontaneous voiding at month one. Mean Qmax was 11,3 +/- 1,7 ml/sec and remained unchanged during the follow-up period. PVR ranged from 55 +/- 17 to 82 +/- 20 ml and IPSS score from10 to 12 points.
Intraprostatic BoNT/A injection is safe and can reduce prostate volume for a period of 18 months. During this time a marked symptomatic improvement can be maintained.
A型肉毒杆菌毒素（BoNT/A）前列腺内注射可诱导前列腺萎缩，并改善良性前列腺增生（BPE）患者的下尿路症状（LUTS）和尿流情况。然而，这些效果的持续时间尚不清楚。本研究的目的是确定单次前列腺内注射200U A型肉毒杆菌毒素后前列腺体积缩小的持续时间。
这是一项为期6个月研究的扩展研究，21例患有难治性尿潴留且不适合手术的体弱老年患者通过超声引导经直肠途径接受了200U BoNT/A前列腺内注射。尽管患者身体虚弱，但仍有11例患者接受了为期18个月的随访。在治疗后1、3、6、12和18个月测定前列腺体积、血清总PSA、最大尿流率（Qmax）、残余尿量（PVR）和国际前列腺症状评分-生活质量（IPSS-QoL）。
基线时平均前列腺体积为82±16ml，从第1个月开始逐渐下降，到第6个月降至49±9.5ml（p = 0.003）。从此时起，前列腺体积缓慢恢复，在18个月时恢复至基线水平（73±16ml，p = 0.03）。血清PSA虽无显著变化，但从基线到第6个月下降了25%。11例患者在第1个月恢复自主排尿。平均Qmax为11.3±1.7ml/秒，在随访期间保持不变。PVR范围为55±17至82±20ml，IPSS评分为10至12分。
前列腺内注射BoNT/A是安全的，可使前列腺体积缩小18个月。在此期间，可维持明显的症状改善。
