Efficacy of transurethral botulinum toxin A injections for bladder outlet obstruction: A systematic review and meta-analysis

Abstract

Introduction:

Botulinum toxin A (BoNT-A) injections in the prostate gland have been used as a minimally invasive option for treating bladder outlet obstruction (BOO). However, the efficacy of transurethral BoNT-A injections for BOO is not well established in the literature. The aim of this study is to collect evidence on the efficacy of transurethral BoNT-A injections for the treatment of BOO.

Materials and methods:

This systematic review and meta-analyses was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A systematic literature search was performed till December 2022. The study population consisted of adult patients diagnosed with BOO, who underwent transurethral injections of BoNT-A for the treatment of BOO.

Evidence synthesis:

Out of 883 records, we identified seven studies enrolling 232 participants, of which only one nonrandomized controlled trial was found. Four prospective studies and two retrospective studies. Three studies included patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) and were included in the meta-analysis. Three studies included patients with urethral sphincter hyperactivity. One study included patients with primary bladder neck disease (PBND). All studies showed significant improvements from baseline in maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR) at 3 and 6 months. The adverse events were mild in all studies. Hematuria, UTI, and urinary retention were reported across all studies.

Conclusion:

In conclusion, transurethral BoNT-A injections have been shown to improve LUTS, QoL, and urodynamic parameters of individuals with BOO at 3 and 6 months after injections, and no serious adverse effects have been reported. However, data on the long-term benefits of this treatment are scarce, and more prospective, randomized studies with larger samples examining various injection techniques, dosages, and extended follow-up of recurrent injections are needed.

Keywords

Bladder outlet obstruction bladder neck disease BPH meta-analysis botulinum

Get full access to this article

View all access options for this article.

References

D’Ancona

Haylen

Oelke

, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn 2019; 38(2): 433–477.

Duchen

LW.

Changes in motor innervation and cholinesterase localization induced by botulinum toxin in skeletal muscle of the mouse: differences between fast and slow muscles. J Neurol Neurosurg Psychiatry 1970; 33(1): 40–54.

Bientinesi

Coluzzi

Gavi

, et al. The impact of neurogenic lower urinary tract symptoms and erectile dysfunctions on marital relationship in men with multiple sclerosis: a single cohort study. J Clin Med 2022; 11(19): 5639.

Grazko

Polo

Jabbari

Botulinum toxin A for spasticity, muscle spasms, and rigidity. Neurology 1995; 45(4): 712–717.

Oeconomou

Madersbacher

Kiss

, et al. Is Botulinum Neurotoxin Type A (BoNT-A) a novel therapy for lower urinary tract symptoms due to benign prostatic enlargement? A review of the literature. Eur Urol 2008; 54(4): 765–777.

Goel

Pierce

Pain

, et al. Use of botulinum toxin A (BoNT-A) in detrusor external sphincter dyssynergia (DESD): a systematic review and meta-analysis. Urology 2020; 140: 7–13.

Moher

Shamseer

Clarke

, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4(1): 1.

Ouzzani

Hammady

Fedorowicz

, et al. Rayyan – Intelligent Systematic Review - Rayyan [Internet], https://www.rayyan.ai/ (2021, accessed 15 January 2023).

Kuo

HC.

Prostate botulinum A toxin injection–an alternative treatment for benign prostatic obstruction in poor surgical candidates. Urology 2005; 65(4): 670–674.

10.

Arnouk

Suzuki Bellucci

Stull

, et al. Botulinum neurotoxin Type A for the treatment of benign prostatic hyperplasia: randomized study comparing two doses. Sci World J 2012; 2012: 1–6.

11.

Hamidi Madani

Enshaei

Heidarzadeh

, et al. Transurethral intraprostatic botulinum toxin-A injection: a novel treatment for BPH refractory to current medical therapy in poor surgical candidates. World J Urol 2013; 31(1): 235–239.

12.

Sacco

Tienforti

Bientinesi

, et al. Onabotulinumtoxin A injection therapy in men with LUTS due to primary bladder-neck dysfunction: objective and patient-reported outcomes. Neurourol Urodyn 2014; 33(1): 142–146.

13.

Jiang

Chen

Jhang

, et al. Therapeutic effect of urethral sphincter onabotulinumtoxinA injection for urethral sphincter hyperactivity. Neurourol Urodyn 2018; 37(8): 2651–2657.

14.

Chen

Bih

Huang

, et al. Effect of single botulinum toxin A injection to the external urethral sphincter for treating detrusor external sphincter dyssynergia in spinal cord injury. J Rehabil Med 2008; 40(9): 744–748.

15.

Kuo

HC.

Satisfaction with urethral injection of botulinum toxin A for detrusor sphincter dyssynergia in patients with spinal cord lesion. Neurourol Urodyn 2008; 27(8): 793–796.

16.

Berges

The impact of treatment on lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) progression. Eur Urol Suppl 2004; 3(4): 12–17.

17.

Moore

LA.

Intimacy and multiple sclerosis. Nurs Clin North Am 2007; 42(4): 605–619.

18.

Eldred-Evans

Dasgupta

Use of botulinum toxin for voiding dysfunction. Transl Androl Urol 2017; 6(2): 234–251.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB