Relief by botulinum toxin of voiding dysfunction due to prostatitis

摘要: Obstructive urinary symptoms due to chronic non-bacterial prostatitis are incomplete relaxation of the bladder neck or inappropriate contraction external urethral sphincter during voiding. Patients may respond adrenergic blocking drugs; if effective, treatment need be continued indefinitely. Botulinum toxin has been used weaken striated and smooth muscles. Toxin injections into relieve obstruction were described by Dykstra Sidi. Apart from detrusor-sphincter dyssynergia, we have found no reports in literature on voiding dysfunction prostatitis. Four consecutive men (mean age 30·7 [SD 5·7] years) with poor emptying because spastic duration 18 [3] months), who failed tamsulosin 0·4 mg once daily for more than 4 months enrolled. All patients examined, had uroflowmetric studies assess times flow (TQ) maximum (TQmax), (Qmax), average (Qave), total volume (Vcomp), anorectal manometry at rest (RT) after (MC). An increased value TQ TQmax a normal Qmax was taken indicative neck. 1, 4, 8 weeks treatment, underwent same assessments. With patient lying his left side, 26-gauge monopolar needle electrode inserted perineum anterior midline, about 1·5–2·0 cm anus directed toward prostatic apex, without sedation local anaesthesia. 30 U type A botulinum injected. No complications systemic side-effects seen. Within 1 week injection all striking improvement their voiding; none complained incontinence. At weeks, three showed continuing improvement. satisfied therapy them The followed up mean 12 months. relapse occurred improved. 6 fourth reported worsening He also depressed required fluoxetine. re-treated 50 Uroflowmetric study decrease values compared baseline (table). Other variables not changed.