Short-Term Benefit With Botox in LUTS Due to Bladder-Neck Dysfunction

E Sacco, D Tienforti, R Bientinesi, A D'Addessi, M Racioppi, F Pinto, A Totaro, M Vittori, D D'Agostino, P Bassi

LUTSABSTRACT

OBJECTIVE 
To determine efficacy and safety of OnabotulinumtoxinA (BoNT-A) injection therapy in medically refractory patients with lower urinary tract symptoms (LUTS) due to primary bladder-neck dysfunction (PBND).

MATERIALS AND METHODS
Thirty-five consecutive ambulatory males diagnosed with PBND and refractory to medical therapy, with IPSS > 15, Qmax < 15 ml/sec, and total prostate volume < 30 cm(3) , were screened from January 2010 to December 2011. Eligible patients underwent transurethral bladder-neck injection of BoNT-A (200 U, 50 U/ml × 4 sites) and were assessed at baseline, 2-, 6-, 9-, and 12-month postprocedure and until duration of clinical response. The primary outcome was the change from baseline in total IPSS, and secondary outcome were storage- and voiding-IPSS, QoL score, Qmax, and postvoiding residual volume (PVR), patient-reported outcomes. Adverse effects were also recorded, including ejaculatory dysfunctions.

RESULTS
Of 30 enrolled patients (mean age 33.8 years), 29 (96.7%) completed the study. A statistically significant improvement of total IPSS was observed from 21.9 at baseline, to 7.8, 10.3, and 16.6 at 2, 6, and 9 months, respectively (P < 0.000). Statistically significant improvements from baseline of storage- and voiding-IPSS, QoL score, Qmax, and PVR were also observed until 9-month postprocedure. The proportion of patients with overall satisfaction was favorable although decreasing from 80% at 2 months, to 44.8% at 12 months. No significant adverse effects or ejaculatory dysfunctions were noted.

CONCLUSIONS
BoNT-A injection therapy appears effective and safe in medically refractory men with PBND, although repeated procedures are required for long-term sustained benefit. Randomized controlled trials are warranted in order to corroborate these results.

E Sacco, D Tienforti, R Bientinesi, A D'Addessi, M Racioppi, F Pinto, A Totaro, M Vittori, D D'Agostino, P Bassi. OnabotulinumtoxinA Injection Therapy in Men With LUTS Due to Primary Bladder-Neck Dysfunction: Objective and Patient-Reported Outcomes. Neurourol Urodyn 2014 Jan 01; 33(1)142-146,