Ilie Cristian P, Chancellor Michael B, Chuang Yao-Chi, Dan Mischianu
Urology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
J Med Life. 2009 Oct-Dec;2(4):338-42.
Histological evidence of benign prostatic hyperplasia (BPH) exceeded 50% in men over 50 years of age and rose to 75% as men entered the eighth decade. Therapeutic options for BPH generally fall into one of the three categories: watchful waiting, medical treatment and surgery. Excluding watchful waiting, the other forms of intervention directed at modifying the physiologic effects of BPH with or without directly altering the prostatic mass or its configuration come with varying effectiveness and risk. Botulinum toxin (BTX-A) produce inhibition of acethylcholine release at the neuromuscular junction causes paralyzing effects and atrophy of striated as well as the smooth muscle fiber. BTX-A also causes inhibitory effects on the ganglionic and post-ganglionic fibres of autonomic nervous system inducing diffuse atrophy and apoptosis of nasal and prostate glands. Clinical series demonstrates efficacy of BTX-A in alleviating symptoms induced by BPH. Larger randomized clinical trials studies are necessary in order to identify the mechanisms by which BTX-A affects the prostate, the ideal dose and the duration of effect. BTX-A injected into prostate appears safe and effective.
50岁以上男性良性前列腺增生（BPH）的组织学证据超过50%，进入八十岁时这一比例升至75%。BPH的治疗选择通常分为三类：观察等待、药物治疗和手术。除观察等待外，其他旨在改变BPH生理效应（无论是否直接改变前列腺体积或其形态）的干预形式，其有效性和风险各不相同。肉毒杆菌毒素（BTX-A）在神经肌肉接头处抑制乙酰胆碱释放，导致麻痹效应以及横纹肌和平滑肌纤维萎缩。BTX-A还对自主神经系统的神经节和节后纤维产生抑制作用，导致鼻腺和前列腺弥漫性萎缩和凋亡。临床系列研究证明BTX-A在缓解BPH所致症状方面有效。需要进行更大规模的随机临床试验研究，以确定BTX-A影响前列腺的机制、理想剂量和作用持续时间。注入前列腺的BTX-A似乎安全有效。
