Transperineal intraprostatic injection treatment of benign prostatic enlargement.

Thirty-nine patients with benign prostatic enlargement were treated by transperineal intrasprostatic injections composed of phenol 2%, glacial acetic acid 2%, and glycerine 4%, in distilled water. A success rate of 56.41% was achieved, which is much less than that previously reported. Complications were negligible. Follow-up for two years was satisfactory. The patients in whom injection therapy failed could still be treated by any standard operative treatment. Why this mode of treatment was successful in some cases and not in others is not clear.     

Intraprostatic botulinum toxin type a injection in patients unfit for surgery presenting with refractory urinary retention and benign prostatic enlargement. Effect on prostate volume and micturition resumption

OBJECTIVES: To evaluate the effect of intraprostatic injection of botulinum toxin A (BoNTA) on prostate volume and refractory urinary retention in patients with benign prostatic enlargement. METHODS: Twenty-one men with benign prostatic enlargement on chronic indwelling catheter for at least 3 mo who were not candidates for surgery because of poor general condition received 200 U BoNTA in the transition zone by transrectal approach under ultrasound guidance. Patients were reevaluated at 1 and 3 mo posttreatment. RESULTS: Patients had a mean age of 80+/-2 yr. Injections were done without anaesthetic support as an outpatient procedure. No significant local effects occurred. Baseline prostate volume of 70+/-10 ml decreased to 57+/-10 ml (p<0.0006) at 1 mo and to 47+/-7 ml (p=0.03 against 1 mo) at 3 mo. At 1 mo, 16 patients (76%) could resume voiding with a mean Qmax of 9.0+/-1.2 ml/s. At 3 mo, 17 patients (81%) voided with a mean Qmax of 10.3+/-1.4 ml/s. Residual urine was 80+/-19 ml and 92+/-24 ml at the two time points, respectively. Mean serum total PSA decreased from 6.0+/-1.1 ng/ml at baseline to 5.0+/-0.9 ng/ml at 3 mo (p=0.04). CONCLUSIONS: BoNTA injection into the prostate swiftly reduces prostate volume and may be a promising treatment for refractory urinary retention in patients with benign prostatic enlargement who are unfit for surgery. Future studies will determine the duration of BoNTA effect.     

Intravesical prostatic protrusion predicts clinical progression of benign prostatic enlargement in patients receiving medical treatment

Objectives:   To assess intravesical prostatic protrusion (IPP) as a novel predictor of clinical progression in patients with benign prostatic enlargement (BPE).
Methods:   All patients attending the outpatient clinic at our institution who were being treated for lower urinary tract symptoms (LUTS) secondary to BPE between January 1997 and December 2003 were recruited into the study. International Prostate Symptom Score (IPSS) scores, uroflowmetry parameters, post-void residual urine volume (PVR), IPP and serum prostate-specific antigen (PSA) were collected. IPP was classified into Grade 1, 2 or 3. Patients were stratified to different treatment options including watchful waiting, alpha blockers or 5-alpha reductase inhibitors. Those who developed high post-void residual urine volume (>100 mL), acute urinary retention or a deterioration of at least 4 points in IPSS score were considered to have disease progression. Using the Grade 1 IPP group as a reference, the odds ratio for clinical progression of Grade 2 and Grade 3 IPP were calculated by using multivariate analysis.
Results:   A total of 259 patients with a mean age of 63 years (range 50–90 years) and mean follow-up time of 32 months were available for analysis. Fifty-two patients were found to have clinical progression. Odds ratio for progression of a Grade 2 IPP was 5.1 (95% confidence interval [CI] 1.6–16.2) and that of a Grade 3 IPP was 10.4 (95% CI 3.3–33.4).
Conclusion:   A higher IPP grade is associated with a higher risk of clinical progression in BPE. IPP is a useful non-invasive predictor for clinical progression in BPE.     

Ethanol injection for the treatment of benign prostatic hyperplasia

Recent studies examining the benefit of prostatic ethanol injection for symptomatic benign prostatic hyperplasia (BPH) have demonstrated significant postsurgical improvements (after 1 to 3 months) in BPH parameters such as symptom score, flow rate, and postvoid residual. Transperineal and transurethral injection routes have been reported to be safe and well-tolerated in men. Animal and human studies demonstrate that this treatment has a direct necrotic effect on prostatic tissue with negligible systemic absorption. Although this technique demonstrates promise as a minimally invasive treatment for BPH, further study of a large series of men is clearly required to define its benefit.     

Antibody-Induced Failure of Botulinum Toxin Type A Therapy in a Patient with Masseteric Hypertrophy

BACKGROUND With the expanding use of botulinum toxin, much concern about the antibody against botulinum toxin is arising. Unlike neurologic indications such as cervical dystonia, antibody-induced failure of botulinum toxin therapy has never been reported in the cosmetic field.
OBJECTIVE The objective was to describe a case of an antibody-induced failure of botulinum toxin type A (BTX-A) therapy (BOTOX, Allergan, Inc.) that occurred in a patient with masseteric hypertrophy.
METHODS AND MATERIALS We present a 20-year-old girl who developed antibody-induced therapy failure after the fourth injection series. Sixty units of toxin was injected at each series and the intertreatment interval was four to five months.
RESULTS Frontalis test revealed no paresis of muscle after a unilateral injection of BTX-A. Circulating antibodies against BTX-A were detected by indirect enzyme-linked immunosorbent assay and mouse protection assay.
CONCLUSION This case is unique in that, first, immunoresistance developed in a patient of cosmetic indication where only a small dose of BTX-A was administered and, second, antibodies developed on the so-called new formulation of BOTOX. Our case alerts cosmetic surgeons to the importance of antibody against the botulinum toxin.     

Changes in the bladder wall muscle associated with benign prostatic enlargement

Summary In a study of 28 patients with prostatic obstruction, an attempt was made to correlate bladder wall hypertrophy and hyperplasia with objective measurements of prostatic enlargement. Correlation could only be established between the cell and nuclear volume ratio of the bladder muscle and the average urine flow rate.     

Influence of dutasteride treatment on serum hormone levels and aging male symptoms in patients with benign prostatic enlargement

Objectives

To clarify the effects of dutasteride on serum hormone levels and aging male symptoms in patients with benign prostatic enlargement.

Methods

The present prospective study was carried out in 110 symptomatic benign prostatic enlargement patients treated with daily administration of 0.5 mg dutasteride. We analyzed serum hormonal levels and aging related symptoms using a validated Aging Male Symptom questionnaire at baseline and after 3 months of dutasteride treatment.

Results

The mean total testosterone, free testosterone and luteinizing hormone levels after dutasteride treatment were approximately 20% higher than those at baseline. The percentage increases in total and free testosterone levels were negatively correlated with these baseline levels. Baseline age, levels of total testosterone and free testosterone, and the changes in the rate of luteinizing hormone after dutasteride treatment tended to be correlated with an increase in the rate of total testosterone and free testosterone after dutasteride treatment. In a subgroup of 26 patients with moderate‐to‐severe aging male symptoms, poor morning erection and free testosterone levels <8.5 pg/mL, total aging male symptoms, and somatic symptoms scores significantly decreased after dutasteride treatment with an increase of total and free testosterone.

Conclusions

The increase of endogenous free testosterone and total testosterone by dutasteride might bring additional benefits of improvement of aging male‐related symptoms, especially in patients with lower free testosterone baseline levels and moderate‐to‐poor aging‐related symptoms.     

Botulinum a toxin for the treatment of benign prostatic hyperplasia/lower urinary tract symptoms

Botulinum neurotoxin (BoNT) has been called the most poisonous poison and a potential bioterrorism weapon, and yet modern medicine has been able to harvest the elegant and specific activity of this toxin to treat a variety of medical conditions. BoNT application recently has been extended to prostate disorders, and this article reviews the literature on the mechanisms of action and clinical efficacy of BoNT treatment in the prostate. BoNT has demonstrated promising preliminary results for male lower urinary tract symptoms, and translational research suggests novel mechanism of action of BoNT in the prostate. It is important to remember that the application of BoNT in the prostate is not approved by the regulatory agencies and caution should be applied until larger randomized clinical studies are completed.     

A new prostatic stent for the treatment of benign prostatic hyperplasia in high-risk patients

OBJECTIVES: The objective of this study was to evaluate the efficacy and safety of a new prostatic stent (Trestle((R)), Boston Scientific Microvasive) for the treatment of BPH in patients with complete urinary retention and considered to be inoperable. METHODS: The efficacy of the stent was evaluated in terms of return of micturition, level of patient satisfaction, uroflowmetry and residual urine. Any stents removed were examined by infrared spectrophotometry for the presence of crystalline encrustations. RESULTS: From December 1997 to April 1999, 20 stents were inserted under local anaesthesia in 17 patients aged 54-90 years. Stents remained in place for an average of 3.5 months. Two migrations were reported. The mean maximum flow rate was 13.7 ml/s and the mean residual urine was 110 ml. The infrared spectrophotometry study revealed a glycoprotein film on stents in place for 1-6 months, accompanied by uric acid crystals on stents in place for 9 months. CONCLUSION: The Trestle prostatic stent is effective and constitutes a good alternative to surgical treatment in patients with a high operative risk.     

A型肉毒毒素在美容整形外科的临床应用分析

目的:探讨在美容整形外科使用A型肉毒毒素进行面部除皱的临床效果。方法:选取在我院美容整形外科进行面部除皱治疗的患者共184例,根据面部皱纹情况分为鱼尾纹组(72例)、眉间纹组(53例)、额纹组(42)和混合组(17例),分别采用不同的注射方法及注射剂量对不同部位的皱纹进行处理,观察各组皱纹改善效果,并调查患者的满意度。结果:鱼尾纹组治疗有效率为94.5%,眉间纹组为88.7%,额纹组为95.2%,混合组为76.5%,四个组的满意度分别为94.4%、92.5%、92.9%、88.2%,组间比较无统计学意义(P>0.05)。结论:在面部除皱美容中局部应用A型肉毒毒素,可以显著改善患者的面部皱纹情况,疗效显著,且可提高患者的满意度,值得推广应用。     

The Use of Botulinum Toxin Type A in Headache Treatment

Opinion statement