Update in the Use of Botulinum Toxin for the Treatment of Benign Prostatic Hyperplasia/ Lower Urinary Tract Symptoms

Over the past decade there are a number of encouraging reports of clinical success of intraprostatic injection of botulinum toxin A (BoNT/A) as a method of management of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). The rational is a unique dual mechanism of action on the smooth muscle and glandular components of the prostate. BoNT is able to block the presynaptic release of acetylcholine from the parasympathetic efferent nerve. The efficacy may also result from an inhibitory on the ganglionic and post-ganglionic fibers of autonomic nervous system inducing diffuse atrophy and apoptosis of prostate glands. The injection of BoNT/A into the prostate is a minimally invasive outpatient alternative treatment of BPH/LUTS. To date, several studies have demonstrated the efficacy of intraprostatic injection of BoNT/A against symptomatic BPH and this article discusses the efficacy and safety of BoNT therapy for treatment of BPH /LUTS.