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Open Access Highly Accessed Research article

Intraprostatic injection of botulinum toxin type- A relieves bladder outlet obstruction in human and induces prostate apoptosis in dogs

Yao-Chi Chuang1, Chieh-Hsien Tu2, Chao-Cheng Huang3, Hsin-Ju Lin2, Po-Hui Chiang1, Naoki Yoshimura4 and Michael B Chancellor4*

Author Affiliations

1 Department of Urology, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan

2 Department of Veterinary Medicine, National Pingtung University of Science and Technology, Taiwan

3 Department of Pathology, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan

4 Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

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BMC Urology 2006, 6:12  doi:10.1186/1471-2490-6-12

Published: 18 April 2006

Abstract

Background

With the increasing interest with botulinum toxin – A (BTX-A) application in the lower urinary tract, we investigated the BTX-A effects on the canine prostate and also in men with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH).

Methods

Transperineal injection into the prostate using transrectal ultrasound (TRUS) was performed throughout the study. Saline with or without 100 U of BTX-A was injected into mongrel dogs prostate. One or 3 months later, the prostate was harvested for morphologic and apoptotic study. In addition, eight BPH patients refractory to α-blockers were treated with ultrasound guided intraprostatic injection of 200 U of BTX-A.

Results

In the BTX-A treated dogs, atrophy and diffuse apoptosis was observed with H&E stain and TUNEL stain at 1 and 3 months. Clinically, the mean prostate volume, symptom score, and quality of life index were significantly reduced by 18.8%, 73.1%, and 61.5% respectively. Maximal flow rate significantly increased by 72.0%.

Conclusion

Intraprostatic BTX-A injection induces prostate apotosis in dogs and relieves BOO in humans. It is therefore a promising alternative treatment for refractory BOO due to BPH.