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Chemodenervation in Urology. Urol Clin North Am 2022; 49:263-272. [DOI: 10.1016/j.ucl.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mechanism of Action of Botulinum Toxin A in Treatment of Functional Urological Disorders. Toxins (Basel) 2020; 12:toxins12020129. [PMID: 32085522 PMCID: PMC7077222 DOI: 10.3390/toxins12020129] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/03/2020] [Accepted: 02/14/2020] [Indexed: 12/03/2022] Open
Abstract
Intravesical botulinum toxin (BoNT) injection is effective in reducing urgency and urinary incontinence. It temporarily inhibits the detrusor muscle contraction by blocking the release of acetylcholine (Ach) from the preganglionic and postganglionic nerves in the efferent nerves. BoNT-A also blocks ATP release from purinergic efferent nerves in the detrusor muscle. In afferent nerves, BoNT-A injection markedly reduces the urothelial ATP release and increases nitric oxide (NO) release from the urothelium. BoNT-A injection in the urethra or bladder has been developed in the past few decades as the treatment method for detrusor sphincter dyssyndergia, incontinence due to neurogenic or idiopathic detrusor overactivity, sensory disorders, including bladder hypersensitivity, overactive bladder, and interstitial cystitis/chronic pelvic pain syndrome. Although the FDA only approved BoNT-A injection treatment for neurogenic detrusor overactivity and for refractory overactive bladder, emerging clinical trials have demonstrated the benefits of BoNT-A treatment in functional urological disorders. Cautious selection of patients and urodynamic evaluation for confirmation of diagnosis are crucial to maximize the successful outcomes of BoNT-A treatment.
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Moussa AS, Ragheb AM, Abdelbary AM, Ibrahim RM, El Adawy MS, Aref A, Assem A, Elfayoumy H, Elzawy F. Outcome of Botulinum Toxin-A intraprostatic injection for benign prostatic hyperplasia induced lower urinary tract symptoms: A prospective multicenter study. Prostate 2019; 79:1221-1225. [PMID: 31189024 DOI: 10.1002/pros.23805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 03/15/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Our aim was to determine the factors predicting the outcome of intraprostatic injection of Botulinum Toxin-A (BTX-A) in the treatment of benign prostatic hyperplasia (BPH)-induced lower urinary tract symptoms (LUTS) and to evaluate its efficacy and safety. METHODS Between September 2016 and May 2018, 45 Egyptian patients, with BPH-induced LUTS were included; the indication was a failure of medical treatment, unfit, or refusing surgical intervention. Measurements of prostate size by TRUS, total PSA level before and 12 weeks after injection. IPSS, uroflow, and postvoiding residual urine (PVR) were measured before injection, 2, 4, 8 and 12 weeks postinjection. 100 U BTX-A vial was diluted with 10 mL of saline then injected into the transition zone at base and midzone of the prostate by TRUS. RESULTS The mean patients' age was 64.4 ± 6.6 years. Mean baseline IPSS 24.06 decreased to 18.75 at 2 weeks and progressively decreased to 16.37 at 12 weeks (P < 0.001), Q max of 9.08 mL/s. increased to 10.44 at 2 weeks and 11.44 at 12 weeks (P < 0.001), mean prostate volume was 67.44cc; decreased to 66.06cc (P < 0.001) at 12 weeks and mean residual urine was 82.62 mL and decreased to 57.66 mL at 12 weeks. DISCUSSION Intraprostatic injection of BTX-A as modality treatment of LUTS/BPH significantly improve IPSS, Q max , PVR, and decrease prostate volume. We can suspect better results with this line of treatment in patients with IPSS ≤ 22 and Q max ≤ 10 mL/min and prostate volume ≤ 56.5cc.
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Affiliation(s)
- Ayman S Moussa
- Urology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed M Ragheb
- Urology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed M Abdelbary
- Urology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Rabie M Ibrahim
- Urology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mahmoud S El Adawy
- Urology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Ahmad Aref
- Urology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Assem
- Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hany Elfayoumy
- Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Faysal Elzawy
- Urology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Sakalis V, Sfiggas V, Vouros I, Salpiggidis G, Papathanasiou A, Apostolidis A. Combination of solifenacin with tamsulosin reduces prostate volume and vascularity as opposed to tamsulosin monotherapy in patients with benign prostate enlargement and overactive bladder symptoms: Results from a randomized pilot study. Int J Urol 2018; 25:737-745. [DOI: 10.1111/iju.13721] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 05/22/2018] [Indexed: 01/10/2023]
Affiliation(s)
| | | | - Ioannis Vouros
- Department of Urology; Hippokration Hospital; Thessaloniki Greece
| | | | | | - Apostolos Apostolidis
- 2nd Department of Urology; Papageorgiou General Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
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Yin L, Li J, Liao CP, Jason Wu B. Monoamine Oxidase Deficiency Causes Prostate Atrophy and Reduces Prostate Progenitor Cell Activity. Stem Cells 2018; 36:1249-1258. [PMID: 29637670 DOI: 10.1002/stem.2831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 03/01/2018] [Accepted: 03/26/2018] [Indexed: 12/23/2022]
Abstract
Monoamine oxidases (MAOs) degrade a number of biogenic and dietary amines, including monoamine neurotransmitters, and play an essential role in many biological processes. Neurotransmitters and related neural events have been shown to participate in the development, differentiation, and maintenance of diverse tissues and organs by regulating the specialized cellular function and morphological structures of innervated organs such as the prostate. Here we show that mice lacking both MAO isoforms, MAOA and MAOB, exhibit smaller prostate mass and develop epithelial atrophy in the ventral and dorsolateral prostates. The cellular composition of prostate epithelium showed reduced CK5+ or p63+ basal cells, accompanied by lower Sca-1 expression in p63+ basal cells, but intact differentiated CK8+ luminal cells in MAOA/B-deficient mouse prostates. MAOA/B ablation also decreased epithelial cell proliferation without affecting cell apoptosis in mouse prostates. Using a human prostate epithelial cell line, we found that stable knockdown of MAOA and MAOB impaired the capacity of prostate stem cells to form spheres, coinciding with a reduced CD133+ /CD44+ /CD24- stem cell population and less expression of CK5 and select stem cell markers, including ALDH1A1, TROP2, and CD166. Alternative pharmacological inhibition of MAOs also repressed prostate cell stemness. In addition, we found elevated expression of MAOA and MAOB in epithelial and/or stromal components of human prostate hyperplasia samples compared with normal prostate tissues. Taken together, our findings reveal critical roles for MAOs in the regulation of prostate basal progenitor cells and prostate maintenance. Stem Cells 2018;36:1249-1258.
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Affiliation(s)
- Lijuan Yin
- Uro-Oncology Research Program, Samuel Oschin Comprehensive Cancer Institute, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jingjing Li
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Chun-Peng Liao
- Lawrence J. Ellison Institute for Transformative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Boyang Jason Wu
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
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Botulinum toxin A treatment for lower urinary tract symptoms/benign prostatic hyperplasia. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2017.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ergün O, Koşar PA, Onaran İ, Darici H, Koşar A. Lysozyme gene treatment in testosterone induced benign prostate hyperplasia rat model and comparasion of its' effectiveness with botulinum toxin injection. Int Braz J Urol 2017; 43:1167-1175. [PMID: 28727388 PMCID: PMC5734082 DOI: 10.1590/s1677-5538.ibju.2016.0677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 02/08/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To compare the effects and histopathological changes of botulinum neurotoxin type A and lysozyme gene injections into prostate tissue within a testosterone induced benign prostate hyperplasia rat model. MATERIALS AND METHODS 40 male Wistar rats were randomized into four Groups. Group-1: Control, Group-2: Testosterone replacement, Group-3: Testosterone+botulinum neurotoxin type A, Group-4: Testosterone+plazmid DNA/liposome complex. RESULTS Estimated prostate volume of the testosterone injected Groups were higher than the control (p <0.05). Actual prostate weight of the testosterone injected Groups was higher than the control Group (p <0.05). Testosterone undecanoate increased the prostate weight by 39%. Botulinum neurotoxin type A treatment led to an estimated prostate volume and actual prostate weights decreased up to 32.5% in rats leading to prostate apoptosis. Lysozyme gene treatment led to an estimated prostate volume and actual prostate weights decrease up to 38.7%. CONCLUSION Lysozyme gene and botulinum neurotoxin type A treatments for prostate volume decreasing effect have been verified in the present study that could be anew modality of treatment in prostatic benign hyperplasia that needs to be verified in large randomized human experimental studies.
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Affiliation(s)
- Osman Ergün
- Department of Urology, Konya Training and Research Hospital, Konya, Turkey
| | - Pinar Aslan Koşar
- Department of Medical Biology and Genetic, Süleyman Demirel University, Isparta, Turkey
| | - İbrahim Onaran
- Department of Medical Biology and Genetic, Süleyman Demirel University, Isparta, Turkey
| | - Hakan Darici
- Deparment of Histology and Embryology, Süleyman Demirel University, Isparta, Turkey
| | - Alim Koşar
- Department of Urology, Süleyman Demirel University, Isparta, Turkey
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Farach A, Ding Y, Lee M, Creighton C, Delk NA, Ittmann M, Miles B, Rowley D, Farach-Carson MC, Ayala GE. Neuronal Trans-Differentiation in Prostate Cancer Cells. Prostate 2016; 76:1312-25. [PMID: 27403603 PMCID: PMC5815867 DOI: 10.1002/pros.23221] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/01/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Neuroendocrine (NE) differentiation in prostate cancer (PCa) is an aggressive phenotype associated with therapy resistance. The complete phenotype of these cells is poorly understood. Clinical classification is based predominantly on the expression of standard NE markers. METHODS We analyzed the phenotype of NE carcinoma of the prostate utilizing in vitro methods, in silico, and immunohistochemical analyses of human disease. RESULTS LNCaP cells, subjected to a variety of stressors (0.1% [v/v] fetal bovine serum, cyclic AMP) induced a reproducible phenotype consistent with neuronal trans-differentiation. Cells developed long cytoplasmic processes resembling neurons. As expected, serum deprived cells had decreased expression in androgen receptor and prostate specific antigen. A significant increase in neuronal markers also was observed. Gene array analysis demonstrated that LNCaP cells subjected to low serum or cAMP showed statistically significant manifestation of a human brain gene expression signature. In an in silico experiment using human data, we identified that only hormone resistant metastatic prostate cancer showed enrichment of the "brain profile." Gene ontology analysis demonstrated categories involved in neuronal differentiation. Three neuronal markers were validated in a large human tissue cohort. CONCLUSION This study proposes that the later stages of PCa evolution involves neuronal trans-differentiation, which would enable PCa cells to acquire independence from the neural axis, critical in primary tumors. Prostate 76:1312-1325, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Andrew Farach
- Department of Radiology, Division of Radiation Oncology, Baylor College of Medicine, Houston, TX
| | - Yi Ding
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX
| | - MinJae Lee
- Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, Houston, TX
| | - Chad Creighton
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Nikki A. Delk
- Department of Biochemistry and Cell Biology, MS-140, Rice University, Houston, Texas
| | - Michael Ittmann
- Department of Pathology, Baylor College of Medicine, Houston, TX
| | - Brian Miles
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - David Rowley
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX
| | - Mary C. Farach-Carson
- Department of Biochemistry and Cell Biology, MS-140, Rice University, Houston, Texas
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX
| | - Gustavo E. Ayala
- Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, Houston, TX
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Cakir OO, Podlasek CA, Wood D, McKenna KE, McVary KT. Effect of Onabotulinum Toxin A on Substance P and Receptor Neurokinin 1 in the Rat Ventral Prostate. ANDROLOGY : OPEN ACCESS 2016; 4. [PMID: 27144785 DOI: 10.4172/2167-0250.1000131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The objective of this work is to examine if sensory innervation impacts lower urinary tract symptoms (LUTS). Onabotulinum toxin A (BoNTA) has been used for the treatment of overactive and neurogenic bladder and as a treatment for LUTS secondary to benign prostatic hyperplasia (BPH). The mechanism of how BoNTA impacts LUTS/BPH is unclear. In rats, BoNTA injection causes prostate denervation, apoptosis and atrophy. In clinical trials reduced prostate size and LUTS are observed inconsistently, suggesting a neurologic component. We will examine if BoNTA treatment inhibits substance P production in sensory nerve fibers in the rat prostate. METHODS Twenty Sprague Dawley rats were divided into four groups including 1X PBS (control, n=6), 2.5 units Onabotulinum toxin A (BoNTA, n=6), 5 units BoNTA (n=6) injected into both lobes of the ventral prostate (VP) and sham surgery (n=2). Rats were Euthanized after one week. Substance P and its receptor neurokinin 1 localization and quantification were performed by counting the number of stained neurons and nerve bundles, by semi-quantitative immunohistochemical analysis and by western analysis. RESULTS Substance P was localized in neuronal axons and bundles in the stroma of the VP but not in the epithelium. Receptor neurokinin 1 was identified in neuronal bundles of the stroma and in columnar epithelium of the VP ducts. Substance P decreased ~90% after BoNTA treatment (p=0.0001) while receptor neurokinin 1 did not change by IHC (p=0.213) or Western (p=0.3675). CONCLUSIONS BoNTA treatment decreases substance P in the rat VP.
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Affiliation(s)
- Omer Onur Cakir
- Department of Urology, Bagcilar Research and Training Hospital, Bagcilar, Istanbul, Turkey
| | - Carol A Podlasek
- Department of Urology, Physiology and Bioengineering, University of Illinois College of Medicine, Chicago, IL 60612, USA
| | - Douglas Wood
- Department of Urology, Bagcilar Research and Training Hospital, Bagcilar, Istanbul, Turkey
| | - Kevin E McKenna
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Kevin T McVary
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL 62794, USA
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Jhang JF, Kuo HC. Botulinum Toxin A and Lower Urinary Tract Dysfunction: Pathophysiology and Mechanisms of Action. Toxins (Basel) 2016; 8:120. [PMID: 27110822 PMCID: PMC4848644 DOI: 10.3390/toxins8040120] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/24/2016] [Accepted: 04/14/2016] [Indexed: 01/23/2023] Open
Abstract
The use of onabotulinumtoxinA (BoNT-A) for the treatment of lower urinary tract diseases (LUTD) has increased markedly in recent years. The indications for BoNT-A treatment of LUTD now include neurogenic or idiopathic detrusor overactivity, interstitial cystitis/bladder pain syndrome and voiding dysfunction. The mechanisms of BoNT-A action on LUTDs affect many different aspects. Traditionally, the effects of BoNT-A were believed to be attributable to inhibition of acetylcholine release from the presynaptic efferent nerves at the neuromuscular junctions in the detrusor or urethral sphincter. BoNT-A injection in the bladder also regulated sensory nerve function by blocking neurotransmitter release and reducing receptor expression in the urothelium. In addition, recent studies revealed an anti-inflammatory effect for BoNT-A. Substance P and nerve growth factor in the urine and bladder tissue decreased after BoNT-A injection. Mast cell activation in the bladder also decreased. BoNT-A-induced improvement of urothelium function plays an important mitigating role in bladder dysfunction. Vascular endothelial growth factor expression in urothelium decreased after BoNT-A injection, as did apoptosis. Studies also revealed increased apoptosis in the prostate after BoNT-A injection. Although BoNT-A injection has been widely used to treat different LUTDs refractory to conventional treatment, currently, onabotulinumtoxinA has been proven effective only on urinary incontinence due to IDO and NDO in several large-scale clinical trials. The effects of onabotulinumtoxinA on other LUTDs such as interstitial cystitis, benign prostatic hyperplasia, dysfunctional voiding or detrusor sphincter dyssynergia have not been well demonstrated.
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Affiliation(s)
- Jia-Fong Jhang
- Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, 707 Chung-Yang Road, Section 3, Hualien 970, Taiwan.
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, 707 Chung-Yang Road, Section 3, Hualien 970, Taiwan.
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Abstract
Botulinum toxin subtype A (BoNT-A) is a potent neurotoxin that can selectively modulate neurotransmitter release from nerve endings, resulting in muscular paralysis. BoNT-A might also act on sensory nerves, and have an anti-inflammatory effect. In the first urological use of BoNT-A, injection into the urethral sphincters of patients with detrusor-sphincter dyssynergia resulted in a reduction of urethral resistance and improved voiding efficiency. Subsequently, intravesical BoNT-A injections have received regulatory approval for treatment of neurogenic detrusor overactivity owing to spinal cord lesions or multiple sclerosis, and idiopathic overactive bladder in adults. BoNT-A has also been widely used to treat patients with the off-label indications of neurogenic or non-neurogenic voiding dysfunction and male lower urinary tract symptoms owing to BPH and bladder-neck dysfunction. Other indications for which urologists have applied BoNT-A injections include interstitial cystitis/bladder pain syndrome, bladder oversensitivity and chronic pelvic pain syndrome. BoNT-A is currently delivered as an intravesical injection; however, use of liposome encapsulated formulations is also beginning to show some therapeutic potential.
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Abstract
PURPOSE OF REVIEW The purpose of this study is to review and discuss recently published (2013-2014) experimental and clinical studies of intraprostatic injection therapy as an alternative treatment of lower urinary tract symptoms (LUTS). RECENT FINDINGS Recent focus has been on intraprostatic injection of botulinum toxin both with regard to mechanism of action and efficacy. In contrast to the promising findings in several previous studies, a recent large, randomized, placebo-controlled trial found no differences between onabotulinumtoxin A treatment and placebo. There is little new information on the use of anhydrous ethanol and agents such as NX-1207 and PRX302, which previously have been reported to have promising effects. SUMMARY Intraprostatic injection of different agents as a minimally invasive surgical therapy for LUTS associated with benign prostatic hyperplasia seems attractive and may have a potential as a treatment alternative, but so far, available results are not convincing. Further studies on the mechanisms of action of novel agents, and controlled clinical trials documenting their efficacy and side-effects when injected into the prostate are needed before their place in the treatment of benign prostatic hyperplasia/LUTS can be properly assessed.
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Magistro G, Stief CG, Gratzke C. New intraprostatic injectables and prostatic urethral lift for male LUTS. Nat Rev Urol 2015. [PMID: 26195444 DOI: 10.1038/nrurol.2015.169] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Treatment modalities for male lower urinary tract symptoms (LUTS) comprise a broad spectrum of medical and surgical options. Interest is growing in minimally invasive treatment options, which should ideally be performed in an outpatient setting and have a short recovery time, durable efficacy and a good safety profile. The preservation of all aspects of sexual function, including antegrade ejaculation, seems to be increasingly important for patients. Initial experimental data on new minimally invasive procedures-such as the intraprostatic injection of novel agents including botulinum neurotoxin A (BoNT-A), NX-1207 and PRX302-were promising, but clinical trials have not confirmed the findings. Trials of the mechanical prostatic urethral lift device-Urolift(®) (Neotract, Inc., USA)-have been positive, but further long-term results are needed to confirm its beneficial effects.
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Affiliation(s)
- Giuseppe Magistro
- Urologische Klinik und Poliklinik, Klinikum der Universität München-Campus Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christian G Stief
- Urologische Klinik und Poliklinik, Klinikum der Universität München-Campus Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christian Gratzke
- Urologische Klinik und Poliklinik, Klinikum der Universität München-Campus Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany
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Blankstein U, Chughtai B, Elterman DS. Relationship Between the Metabolic Syndrome and BPH-Related Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0230-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zhang X, Zeng X, Liu Y, Dong L, Zhao X, Qu X. Impact of metabolic syndrome on benign prostatic hyperplasia in elderly Chinese men. Urol Int 2014; 93:214-9. [PMID: 24862628 DOI: 10.1159/000357760] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/13/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the impact of metabolic syndrome (MetS) on benign prostatic hyperplasia (BPH) in elderly Chinese men. METHODS A total of 401 elderly BPH patients were divided into the without or with MetS group to assess the associations of MetS and components of MetS with BPH. Urologic evaluation included prostate volume, International Prostate Symptom Score, serum prostate-specific antigen, duration of concomitant lower urinary tract symptoms (LUTS) and maximum flow rate. RESULTS Body mass index (BMI), waist circumference, fasting glucose, glycosylated hemoglobin, triglyceride, fasting insulin (FINS), insulin resistance assessed by homeostasis model assessment (HOMA-IR) were greater and high-density lipoprotein cholesterol (HDL-C) was lower in BPH patients with MetS than in those without MetS. The patients with MetS showed a significantly larger prostate volume (p = 0.000) and longer duration of LUTS (p = 0.006) than those without MetS. Prostate volume was positively correlated with BMI (p = 0.000), FINS (p = 0.001), HOMA-IR (p = 0.003) and inversely correlated with HDL-C (p = 0.000). Multiple linear regression analysis showed that prostate volume was significantly correlated with HOMA-IR (p = 0.015). CONCLUSIONS Our results suggest that MetS, BMI, low HDL-C level, increased serum insulin and especially insulin resistance are considered risk factors for prostate enlargement in elderly Chinese men.
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Affiliation(s)
- Xiangyu Zhang
- Department of Geriatrics, Second Xiangya Hospital of Central South University, Changsha, P.R. China
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Cheng YT, Chung YH, Kang HY, Tai MH, Chancellor MB, Chuang YC. OnobotulinumtoxinA Has No Effects on Growth of LNCaP and PC3 Human Prostate Cancer Cells. Low Urin Tract Symptoms 2013; 5:168-72. [PMID: 26663455 DOI: 10.1111/luts.12003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Intraprostatic injection of botulinum toxin (BTX) has been reported to have therapeutic effects on lower urinary tract symptoms related to benign prostate hyperplasia (BPH). Patients with BPH are at risk of having prostate cancer. The present study was conducted to assess the effect of onobotulinumtoxinA on prostate cancer in vitro and in vivo. METHODS Human prostate cancer cell lines, LNCaP and PC3 were exposed to different doses of onobotulinumtoxinA (0-10 U; Allergan, Irvine, CA, USA). Cell viability, DNA fragmentation and apoptosis assay were subsequently measured. For the in vivo study, LNCaP and PC3 xenografts were introduced into nude mice and treated with intra-tumoral onobotulinumtoxinA or saline injection. Tumor volume, histopathology and apoptosis were assessed. Presence of SNAP-25 protein, the molecular target of onobotulinumtoxinA, was studied in both cell lines by Western blot analysis. RESULTS OnobotulinumtoxinA did not significantly affect cell proliferation or apoptosis in LNCaP and PC3 cells. There was no significant difference in tumor size and histopathological findings between the experimental and control groups. There was no detectable SNAP-25 protein in both cell lines. CONCLUSION OnobotulinumtoxinA does not affect the growth of LNCaP or PC3 cells in vitro and in vivo or produce significant anti-tumor effects. Intraprostatic BTX injection for BPH might not affect the growth of prostate cancer.
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Affiliation(s)
- Yuan-Tso Cheng
- Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, TaiwanCenter for Menopause and Reproductive Medicine Research, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, TaiwanInstitute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, TaiwanDepartment of Urology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Yueh-Hua Chung
- Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, TaiwanCenter for Menopause and Reproductive Medicine Research, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, TaiwanInstitute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, TaiwanDepartment of Urology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Hong-Yo Kang
- Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, TaiwanCenter for Menopause and Reproductive Medicine Research, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, TaiwanInstitute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, TaiwanDepartment of Urology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Ming-Hong Tai
- Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, TaiwanCenter for Menopause and Reproductive Medicine Research, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, TaiwanInstitute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, TaiwanDepartment of Urology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Michael B Chancellor
- Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, TaiwanCenter for Menopause and Reproductive Medicine Research, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, TaiwanInstitute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, TaiwanDepartment of Urology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Yao-Chi Chuang
- Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, TaiwanCenter for Menopause and Reproductive Medicine Research, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, TaiwanInstitute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, TaiwanDepartment of Urology, William Beaumont Hospital, Royal Oak, Michigan, USA
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Arenas da Silva LF, Schönthaler M, Cruz F, Gratzke C, Zumbe J, Stenzl A, Amend B, Sievert KD. [New treatment strategies for male lower urinary tract symptoms]. Urologe A 2013; 51:1697-702. [PMID: 23139025 DOI: 10.1007/s00120-012-3032-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
For patients with lower urinary tract symptoms (LUTS), α1-adrenoreceptor inhibitors and 5-alpha reductase inhibitors as well as their combination are considered the gold standard. In addition, anticholinergic agents are being introduced as monotherapy or in combination with α1-adrenocepetor inhibitors for patients with predominant storage disorders. Phosphodiesterase 5 (PDE5) inhibitors are often the best option for patients with LUTS who also suffer from erectile dysfunction. Recently, novel treatment options have been presented and intraprostatic injection of various agents, such as botulinum toxin A, NX-1207 and PRX302 has shown promising initial results. In addition, innovative minimally invasive treatment options, such as UroLift® appear to be efficacious and safe in this patient cohort. Particular emphasis should be laid on patients with LUTS and concomitant sexual disorders.
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Affiliation(s)
- L F Arenas da Silva
- Klinik für Urologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Deutschland
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Cruz F. Targets for botulinum toxin in the lower urinary tract. Neurourol Urodyn 2013; 33:31-8. [DOI: 10.1002/nau.22445] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/15/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Francisco Cruz
- Department of Urology and IBMC; Hospital de São João and Faculty of Medicine of Porto; Porto Portugal
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Abstract
PURPOSE OF REVIEW Transurethral resection of the prostate has long been held as the gold standard for treatment of benign prostatic hyperplasia (BPH); however, there have been significant innovations in other less invasive alternative treatments for BPH in recent years. Our purpose is to present emerging surgical treatment modalities which have been presented in the last 12 months. RECENT FINDINGS We report recent results in different treatment options for BPH. The concept of stenting the urethra has already been introduced nearly 20 years ago in urology and like intraprostatic injection of botulinum toxin it has found application in urological treatment of bladder outlet obstruction. The prostatic urethral lift procedure is a novel surgical minimal invasive approach needing long-term results. Intraprostatic injections with NX-1207 and histotripsy fractionation of prostate tissue are treatment modalities, which are currently under evaluation for a clinical application in humans. SUMMARY Anaesthesia-free outpatient capability, lack of sexual side-effects and avoidance of actual surgery are attractive to patient and clinician alike. Some of the presented treatments may establish in clinical practice as a suitable treatment alternative to transurethral resection of the prostate and medical therapy.
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Bschleipfer T, Bach T, Gratzke C, Madersbacher S, Oelke M. [Intraprostatic injection therapy in patients with benign prostatic syndrome]. Urologe A 2013; 52:354-8. [PMID: 23435646 DOI: 10.1007/s00120-012-3091-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Intraprostatic injection therapy is a minimally invasive treatment of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia and could be a therapeutic alternative in increasingly older and co-morbid patients. Nowadays only botulinum neurotoxin A (BoNT/A), absolute ethanol, NX-1207 and PRX302 are of relevance but none of these substances has yet been authorized for treatment use (off-label use). There have been only three randomized, placebo-controlled trials (RCTs) for BoNT/A, whereas none exist for ethanol and the results of existing studies are inconsistent and without convincing proof of efficacy. NX-1207 is a protein with selective pro-apoptotic properties and non-inferiority compared to finasteride has been demonstrated. PRX302 is a modified proaerolysin that can be activated by prostate-specific antigen and is therefore (prostate) cell-specific. Safety and efficacy are well documented; however, intraprostatic injection therapy should presently only be performed in clinical trials, irrespective of the substance used.
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Affiliation(s)
- T Bschleipfer
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Straße 7, 35392 Gießen, Deutschland.
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Pannek J, Bartel P, Göcking K, Frotzler A. Prostate volume in male patients with spinal cord injury: a question of nerves? BJU Int 2013; 112:495-500. [PMID: 23418778 DOI: 10.1111/bju.12027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the influence of standardized complete surgical deafferentation of the lower urinary tract by sacral deafferentation (SDAF) and sacral anterior root stimulation (SARS) on prostate volume in men with spinal cord injury (SCI). PATIENTS AND METHODS In a prospective study, the prostate volume of men with SCI who underwent SDAF/SARS was measured using transrectal ultrasonography. The prostate volumes of these men were compared with those of men with complete SCI but who did not undergo SDAF/SARS, those of men with incomplete SCI, and those of a historical sample of able-bodied men. RESULTS The median [25th;75th percentile] prostate volume of men who underwent SDAF/SARS (20.0 [14.0; 29.0]) and of men with complete SCI who did not undergo SDAF/SARS (20.0 [16.5; 29.0]) was significantly smaller than in the reference group (25.0 [5.0; 84.0]). The mean prostate volume was associated with age in the reference group (r = 0.185; P < 0.001) and in men with incomplete SCI (r = 0.284; P = 0.031), but not in men with complete SCI, irrespective of SDAF/SARS. CONCLUSIONS The prostate volume of men with complete SCI was significantly smaller than that of able-bodied men. Our data imply that sustained central innervation of the prostate plays an important role in prostate growth.
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Affiliation(s)
- Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland.
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Gravas S, de la Rosette JJMCH. Investigational therapies targeted to the treatment of benign prostatic hyperplasia. Expert Opin Investig Drugs 2013; 22:357-68. [DOI: 10.1517/13543784.2013.761973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Andersson KE. Treatment of lower urinary tract symptoms: agents for intraprostatic injection. Scand J Urol 2013; 47:83-90. [PMID: 23281591 DOI: 10.3109/00365599.2012.752404] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
When the currently available pharmacotherapeutic principles used for treatment of male lower urinary tract symptoms (LUTS) fail, transurethral resection of the prostate still remains the widely applied gold-standard therapy, since the majority of minimally invasive therapies have not achieved the same efficacy and/or lack an evidence base to support their routine use. Intraprostatic injection therapy, which probably is the oldest minimally invasive surgical treatment, has not been widely used, but recent reports of successful treatments with several new agents have renewed interest in this approach. Anhydrous ethanol still seems to be one of the most extensively studied injectables to date, but intraprostatic injection of botulinum toxin has received much recent attention, with regard to both its mechanism of action and efficacy. In addition, other agents such as NX-1207 and PRX302 have been reported to have promising effects. Injection therapy, using the transperineal, transrectal and transurethral routes for delivery of the active compounds, seems to be an effective minimally invasive surgical therapy for LUTS associated with benign prostatic hyperplasia (BPH). However, further studies on mechanisms of action of the novel agents used, and controlled clinical trials documenting their efficacy and side-effects (which are largely lacking), are needed before their place in the treatment of BPH/LUTS can be properly assessed.
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Affiliation(s)
- Karl-Erik Andersson
- Institute of Regenerative Medicine, Wake Forest University School of Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, USA.
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de Kort LMO, Kok ET, Jonges TN, Rosier PFWM, Bosch JLHR. Urodynamic effects of transrectal intraprostatic Ona botulinum toxin A injections for symptomatic benign prostatic hyperplasia. Urology 2012; 80:889-93. [PMID: 22854138 DOI: 10.1016/j.urology.2012.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 05/26/2012] [Accepted: 06/02/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate urodynamic, symptomatic, and histologic effects of intraprostatic injection with Ona botulinum toxin A for benign prostatic hyperplasia. METHODS Patients >55 years with symptomatic benign prostatic hyperplasia failing medical therapy were treated. Inclusion criteria were International Prostate Symptom Score >7, prostate volume 30-50 cm(3), and urodynamic bladder outlet obstruction >Schäfer grade 2. A transrectal intraprostatic injection of 200 IU Ona botulinum toxin A was given. Filling cystometry and pressure flow studies were performed at 3, 6, and 12 months post injection. International Prostate Symptom Score, International Prostate Symptom Score quality of life, prostate-specific antigen, and prostate volume were measured up until 12 months; prostate biopsies before and after Ona botulinum toxin A injection were done for histology and cell proliferation. RESULTS Fifteen men (mean age 64.9 years) were included. Ona botulinum toxin A injection was well tolerated with few complications. Postvoid residual improved (170 to 80 mL), but maximum flow rate and bladder outlet resistance parameters did not change during follow-up. International Prostate Symptom Score and International Prostate Symptom Score quality of life improved (22 to 13 and 5 to 2, respectively), whereas prostate-specific antigen and prostate volume remained unaltered. Cell proliferation did not decrease and in 37% and 64% of pre- and posttreatment biopsies, respectively, some degree of prostatitis was found. Ten of 15 patients eventually underwent transurethral prostate resection because of persisting symptoms. CONCLUSION Intraprostatic Ona botulinum toxin A for symptomatic benign prostatic hyperplasia did not affect urodynamic outcomes, except for postvoid residual. Although symptom scores improved, we were not able to show change in prostate volume, prostate-specific antigen, or histologic outcomes. A placebo effect of intraprostatic Ona botulinum toxin A could not be ruled out.
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Affiliation(s)
- Laetitia M O de Kort
- Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands.
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Abstract
Botulinum toxin has been recently accepted as a novel treatment for lower urinary tract dysfunctions refractory to conventional treatment. Review of the clinical trials in recent years, botulinum toxin type A has been widely used in the urethra or urinary bladder to treat voiding dysfunction due to detrusor sphincter dyssynergia, incontinence due to neurogenic or idiopathic detrusor overactivity, sensory disorders such as bladder hypersensitivity, overactive bladder, and interstitial cystitis/painful bladder syndrome. Intravesical botulinum toxin type A injection is effective in treatment of urinary incontinence due to detrusor overactivity in men and women, as well as in children. Currently botulinum toxin type A has also been applied to treat lower urinary tract symptoms due to benign prostatic hyperplasia in patients not suitable for surgery. This article reviewed the recent advances of botulinum toxin type A on lower urinary tract dysfunction.
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Affiliation(s)
- Yue-Chen Kuo
- Department of Urology, Yangming Branch of Taipei City Hospital, Taipei, Taiwan
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Gorgal T, Charrua A, Silva JF, Avelino A, Dinis P, Cruz F. Expression of apoptosis-regulating genes in the rat prostate following botulinum toxin type A injection. BMC Urol 2012; 12:1. [PMID: 22216975 PMCID: PMC3265407 DOI: 10.1186/1471-2490-12-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 01/04/2012] [Indexed: 01/18/2023] Open
Abstract
Background Onabotulinumtoxin A (OnabotA) injection has been investigated as a novel treatment for benign prostatic enlargement caused by benign prostatic hyperplasia. An OnabotA - induced volume reduction caused by sympathetic fibers impairment has been proposed as a potential mechanism of action. Our aim was to investigate the expression of apoptosis-regulating proteins in the rat prostate following OnabotA intraprostatic injection. Methods Adult Wistar rats were injected in the ventral lobes of the prostate with 10 U of OnabotA or saline. A set of OnabotA-injected animals was further treated with 0.5 mg/kg of phenylephrine (PHE) subcutaneously daily. All animals were sacrificed after 1 week and had their prostates harvested. Immunohistochemical staining was performed for Bax, Bcl-xL and caspase-3 proteins and visualized by the avidin-biotin method. The optical density of the glandular cells was also determined, with measurement of differences between average optical densities for each group. Results Saline-treated animals showed intense epithelial staining for Bcl-xL and a faint labelling for both Bax and Caspase-3. OnabotA-treated rats showed a reduced epithelial staining of Bcl-xL and a consistently increased Bax and Caspase-3 staining when compared with saline-treated animals. PHE-treated animals showed a stronger Bcl-xL staining and reduced staining of both Bax and Caspase-3 when compared to the OnabotA group. Mean signal intensity measurements for each immunoreaction confirmed a significant decrease of the signal intensity for Bcl-xL and a significant increase of the signal intensity for Bax and Caspase 3 in OnabotA-injected animals when compared with the control group. In OnabotA+PHE treated animals mean signal intensity for Bcl-xL, Bax and Caspase 3 immunoreactions was identical to that of the control animals. Conclusions These results support the hypothesis that OnabotA activates apoptotic pathways in the rat prostate through a mechanism that involves sympathetic outflow impairment.
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Affiliation(s)
- Tiago Gorgal
- Department of Urology, Hospital de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto-Portugal
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Marchal C, Perez JE, Herrera B, Machuca FJ, Redondo M. The use of botulinum toxin in benign prostatic hyperplasia. Neurourol Urodyn 2011; 31:86-92. [DOI: 10.1002/nau.21142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 03/22/2011] [Indexed: 11/07/2022]
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Abdollah F, Briganti A, Suardi N, Castiglione F, Gallina A, Capitanio U, Montorsi F. Metabolic syndrome and benign prostatic hyperplasia: evidence of a potential relationship, hypothesized etiology, and prevention. Korean J Urol 2011; 52:507-16. [PMID: 21927696 PMCID: PMC3162215 DOI: 10.4111/kju.2011.52.8.507] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 05/13/2011] [Indexed: 11/18/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is highly prevalent in older men and causes substantial adverse effects on health. The pathogenesis of this disease is not totally clear. Recent reports have suggested a possible relationship between metabolic syndrome (MetS) and BPH. Single components of MetS (obesity, dyslipidemia, hypertension, and insulin resistance) as well as the syndrome itself may predispose patients to a higher risk of BPH and lower urinary tract symptoms (LUTS). This may stem from changes in insulin resistance, increased autonomic activity, impaired nitrergic innervation, increased Rho kinase activity, pro-inflammatory status, and changes in sex hormones that occur in association with MetS. However, the exact underlying mechanisms that regulate the potential relationship between MetS and BPH/LUTS still need to be clarified. Increased physical activity and dietary strategies may help in decreasing the incidence of MetS and its impact on BPH/LUTS. However, differences in the definitions used to address the examined predictors and endpoints preclude the possibility of arriving at definitive conclusions.
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Affiliation(s)
- Firas Abdollah
- Department of Urology, San Raffaele Hospital, Università Vita-Salte, Urological Research Institute (URI), Milan, Italy
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Charrua A, Avelino A, Cruz F. Modulation of urinary bladder innervation: TRPV1 and botulinum toxin A. Handb Exp Pharmacol 2011:345-374. [PMID: 21290235 DOI: 10.1007/978-3-642-16499-6_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The persisting interest around neurotoxins such as vanilloids and botulinum toxin (BoNT) derives from their marked effect on detrusor overactivity refractory to conventional antimuscarinic treatments. In addition, both are administered by intravesical route. This offers three potential advantages. First, intravesical therapy is an easy way to provide high concentrations of pharmacological agents in the bladder tissue without causing unsuitable levels in other organs. Second, drugs effective on the bladder, but inappropriate for systemic administration, can be safely used as it is the case of vanilloids and BoNT. Third, the effects of one single treatment might be extremely longlasting, contributing to render these therapies highly attractive to patients despite the fact that the reasons to the prolonged effect are still incompletely understood. Attractive as it may be, intravesical pharmacological therapy should still be considered as a second-line treatment in patients refractory to conventional oral antimuscarinic therapy or who do not tolerate its systemic side effects. However, the increasing off-label use of these neurotoxins justifies a reappraisal of their pharmacological properties.
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Affiliation(s)
- Ana Charrua
- Institute of Histology and Embryology, Porto, Portugal
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Vikram A, Jena G, Ramarao P. Insulin-resistance reduces botulinum neurotoxin-type A induced prostatic atrophy and apoptosis in rats. Eur J Pharmacol 2011; 650:356-63. [DOI: 10.1016/j.ejphar.2010.09.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Revised: 08/31/2010] [Accepted: 09/20/2010] [Indexed: 01/29/2023]
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Current world literature. Curr Opin Urol 2010; 21:84-91. [PMID: 21127406 DOI: 10.1097/mou.0b013e328341a1a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Silva J, Pinto R, Carvalho T, Botelho F, Silva P, Silva C, Cruz F, Dinis P. Intraprostatic botulinum toxin type A administration: evaluation of the effects on sexual function. BJU Int 2010; 107:1950-4. [DOI: 10.1111/j.1464-410x.2010.09841.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vikram A, Jena G, Ramarao P. Insulin-resistance and benign prostatic hyperplasia: The connection. Eur J Pharmacol 2010; 641:75-81. [DOI: 10.1016/j.ejphar.2010.05.042] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 05/27/2010] [Accepted: 05/28/2010] [Indexed: 10/19/2022]
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Kessler TM, Khan S, Panicker JN, Elneil S, Brandner S, Fowler CJ, Roosen A. In the Human Urothelium and Suburothelium, Intradetrusor Botulinum Neurotoxin Type A Does Not Induce Apoptosis: Preliminary Results. Eur Urol 2010; 57:879-83. [DOI: 10.1016/j.eururo.2009.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
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Abstract
PURPOSE OF REVIEW The injection of botulinum neurotoxin A (BoNT-A) into the prostate represents an alternative, minimal invasive treatment for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH), which gained the interest of urologists during the last years, although it is not yet licensed. The purpose of this review is to summarize the mechanisms through which BoNT-A could inhibit the progression of BPH and eliminate the lower urinary tract symptoms according to the findings of animal studies. Furthermore, we review clinical studies to report the efficacy and safety of intraprostatic BoNT-A injection according to various injection protocols. RECENT FINDINGS The experimental studies report induced relaxation of the prostate, atrophy, and reduction in its size through inhibition of the trophic effect of the autonomic system on the prostate gland. Also, a possible mechanism of reduction in lower urinary tract symptoms might take place through inhibition of sensory afferents from the prostate to the spinal cord. Clinical studies report symptomatic relief and improvement in the measured parameters during the follow-up period, whereas local or systematic side-effects are rare. SUMMARY We should recognize that, at present, this therapy is still experimental. Although the results of the clinical studies are encouraging, the level of evidence is low. Clearly, we need large-scale, clinical, placebo-controlled, randomized studies, including long-term surveillance to document the evidence of this therapy and, eventually, to register BoNT-A for this indication.
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Vikram A, Jena GB, Ramarao P. Increased cell proliferation and contractility of prostate in insulin resistant rats: linking hyperinsulinemia with benign prostate hyperplasia. Prostate 2010; 70:79-89. [PMID: 19790233 DOI: 10.1002/pros.21041] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Obesity, dyslipidemia, Hyperinsulinemia, and insulin resistance (IR) are key features of metabolic syndrome and are considered as risk factors for benign prostatic hyperplasia (BPH) as well as type 2 diabetes. The present study was aimed to determine whether or not IR associated hyperinsulinemia contributes to the BPH. METHODS Sprague-Dawley rats (9 weeks) were used in the study. Rats were kept on high fat diet (HFD) for the induction of hyperinsulinemia while hypoinsulinemia was induced by streptozotocin. Effect of HFD feeding on the testosterone-induced prostatic growth was evaluated. Pioglitazone (PG, 20 mg/kg) was used for the reversal of compensatory hyperinsulinemia and to examine the subsequent effect on the prostatic growth. RESULTS Prostatic enlargement was observed in the HFD-fed rats. Significant increase in the cell proliferation markers confirmed the occurrence of cellular hyperplasia in the prostate of hyperinsulinemic rat. Enhanced alpha-adrenoceptor mediated contraction in the prostate of HFD-fed rats indicates augmented contractility of the gland. Higher level of phosphorylated-ERK suggests enhanced MEK/ERK signaling. HFD feeding has not led to change in the plasma testosterone level. However, testosterone treatment further augmented the prostatic growth in HFD-fed rats. PG treatment led to improved insulin sensitivity, decreased plasma insulin level and prostate weight, indicating the role of compensatory hyperinsulinemia in the prostate growth. CONCLUSIONS The present investigation reports that HFD-feeding induced hyperinsulinemic condition leads to increased cellular proliferation, enhanced alpha-adrenoceptor mediated contraction, and enlargement of the prostate in rats.
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Affiliation(s)
- A Vikram
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Mohali, Punjab, India
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Cruz F, Silva J, Pinto R, Carvallho T, Coelho A, Avelino A, Dinis P. Reply to Tomasz Drewa, Zbigniew Wolski and Janusz Tyloch's Letter to the Editor re: João Silva, Rui Pinto, Tiago Carvallho, et al. Mechanisms of Prostate Atrophy after Glandular Botulinum Neurotoxin Type A Injection: An Experimental Study in the Rat. Eur Urol 2009;56:134–41. Eur Urol 2009. [DOI: 10.1016/j.eururo.2009.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Silva J, Pinto R, Carvalho T, Botelho F, Silva P, Oliveira R, Silva C, Cruz F, Dinis P. Intraprostatic Botulinum Toxin Type A injection in patients with benign prostatic enlargement: duration of the effect of a single treatment. BMC Urol 2009; 9:9. [PMID: 19682392 PMCID: PMC2734751 DOI: 10.1186/1471-2490-9-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 08/15/2009] [Indexed: 12/16/2022] Open
Abstract
Background Botulinum Toxin Type-A (BoNT/A) intraprostatic injection can induce prostatic involution and improve LUTS and urinary flow in patients with Benign Prostatic Enlargement (BPE). However, the duration of these effects is unknown. The objective of this work was to determine the duration of prostate volume reduction after one single intraprostatic injection of 200U of Botulinum Toxin Type-A. Methods This is an extension of a 6 month study in which 21 frail elderly patients with refractory urinary retention and unfit for surgery were submitted to intraprostatic injection of BoNT/A-200U, by ultrasound guided transrectal approach. In spite of frail conditions, eleven patients could be followed during 18 months. Prostate volume, total serum PSA, maximal flow rate (Qmax), residual volume (PVR) and IPSS-QoL scores were determined at 1, 3, 6, 12 and 18 months post-treatment. Results Mean prostate volume at baseline, 82 ± 16 ml progressively decreased from month one coming to 49 ± 9,5 ml (p = 0,003) at month six. From this moment on, prostate volume slowly recovered, becoming identical to baseline at 18 months (73 ± 16 ml, p = 0.03). Albeit non significant, serum PSA showed a 25% decrease from baseline to month 6. The 11 patients resumed spontaneous voiding at month one. Mean Qmax was 11,3 ± 1,7 ml/sec and remained unchanged during the follow-up period. PVR ranged from 55 ± 17 to 82 ± 20 ml and IPSS score from10 to 12 points. Conclusion Intraprostatic BoNT/A injection is safe and can reduce prostate volume for a period of 18 months. During this time a marked symptomatic improvement can be maintained.
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Affiliation(s)
- João Silva
- Department of Urology, Hospital S, João, Porto, Portugal.
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Drewa T, Wolski Z, Tyloch J. Re: João Silva, Rui Pinto, Tiago Carvallho, et al. Mechanisms of prostate atrophy after glandular botulinum neurotoxin type a injection: an experimental study in the rat. Eur Urol 2009;56:134-41. Eur Urol 2009; 56:e27; author reply e28-9. [PMID: 19665287 DOI: 10.1016/j.eururo.2009.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 07/21/2009] [Indexed: 11/25/2022]
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Editorial comment on: Mechanisms of prostate atrophy after glandular botulinum neurotoxin type A injection: an experimental study in the rat. Eur Urol 2008; 56:140-1. [PMID: 18649988 DOI: 10.1016/j.eururo.2008.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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