Botulinum toxin type A improves benign prostatic hyperplasia symptoms in patients with small prostates
Botulinum toxin type A improves benign prostatic hyperplasia symptoms in patients with small prostates
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DOI：
10.1016/j.urology.2005.04.029
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发表时间：
2005-10-01
期刊：
影响因子：
2.1
通讯作者：
Chancellor, MB
中科院分区：
文献类型：
--
作者：
Chuang, YC;Chiang, PH;Chancellor, MB
目标.目的探讨A型肉毒毒素（BTX-A）治疗小前列腺和症状性良性前列腺增生（BPH）的临床应用。BTX-A前列腺注射治疗排尿功能障碍和大前列腺患者已被证实。16名患有症状性BPH、前列腺体积小于30 cm（3）、峰值流速小于12 mL/s、且在α受体阻滞剂治疗至少1个月后患有难治性疾病的男性在经直肠超声引导下经会阴向前列腺注射BTX-A 100 U。分别于治疗前和治疗后进行临床疗效评价。在任何患者中均未观察到显著的局部或全身副作用。所有患者均报告在约1周时开始主观改善，并在1个月后达到最大效果，并在3个月和6个月时维持。随访6 ~ 12个月（平均10个月），无患者症状复发。平均前列腺体积、症状评分和生活质量指数显著降低13.3%（从19.6 +/- 1.2到17.0 +/- 1.1 cm（3）），52.6%（从18.8 +/- 1.6到8.9 +/- 1.9）和44.7%（从3.8 +/- 0.3到2.1 +/- 0.3）。最大流速显著增加39.8%（从7.3 +/- 0.7 mL/s增加至11.8 +/- 0.8 mL/s）。在BTX-A注射后1个月进行活检的2例患者中，末端脱氧核苷酸介导的脱氧尿苷三磷酸缺口末端标记染色显示凋亡活性增加，不仅在腺体成分中，而且在前列腺组织的基质成分中。BTX-A注射到前列腺是一种有前途的治疗小前列腺和症状性BPH患者。
Objectives. To expand the clinical use of botulinum toxin A (BTX-A) in treating patients with small prostates and symptomatic benign prostatic hyperplasia (BPH. BTX-A injection into the prostate in patients with voiding dysfunction and large prostates has been reported.Methods. Sixteen men with symptomatic BPH, a prostate volume less than 30 cm(3), peak flow rate less than 12 mL/s, and with refractory disease after at least I month of alpha-blocker treatment received BTX-A 100 U injection into the prostate transperineally under transrectal ultrasound guidance. The clinical effects were evaluated at baseline and after treatment.Results. No significant local or systemic side effects were observed in any of the patients. All patients reported subjective improvement starting at approximately I week and achieved a maximal effect after 1 month that was maintained at 3 and 6 months. At 6 to 12 months (mean 10) of follow-up, no patient had symptom recurrence. The mean prostate volume, symptom score, and quality-of-life index were significantly reduced by 13.3% (from 19.6 +/- 1.2 to 17.0 +/- 1.1 cm(3)), 52.6% (from 18.8 +/- 1.6 to 8.9 +/- 1.9), and 44.7% (from 3.8 +/- 0.3 to 2.1 +/- 0.3), respectively. The maximal flow rate increased significantly by 39.8% (from 7.3 +/- 0.7 to 11.8 +/- 0.8 mL/s). In 2 patients who underwent biopsy 1 month after BTX-A injection, terminal deoxynucleotidyl-mediated deoxyuridine triphosphate nick end labeling staining demonstrated an increase in apoptotic activity, not only in the glandular component, but also in the stromal component of the prostatic tissue.Conclusions. BTX-A injected into the prostate is a promising treatment for patients with small prostates and symptomatic BPH.