Transurethral intraprostatic injection of Botulinum A for CPPS

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Chriss
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Transurethral intraprostatic injection of Botulinum A for CPPS

Post by Chriss »

Hi Guys,
It would be grateful, to have your feedbacks in ideas about:
https://pubmed.ncbi.nlm.nih.gov/25307409
Transurethral intraprostatic injection of botulinum neurotoxin type A for the treatment of chronic prostatitis/chronic pelvic pain syndrome: results of a prospective pilot double-blind and randomized placebo-controlled study.

Abstract

OBJECTIVE: To evaluate the effect of botulinum neurotoxin type-A (BoNT-A) on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) refractory to medical therapy.

MATERIALS AND METHODS: Between November 2011 and January 2013, 60 men aged ≥18 years with CP/CPPS, and with National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores ≥10 and pain subscale scores ≥8, who were refractory to 4-6 weeks' medical therapy, underwent transurethral intraprostatic injection of BoNT-A or normal saline in a prospective pilot double-blind randomized study. The patients' NIH-CPSI total and subscale scores, American Urological Association (AUA)-symptom score (SS), visual analogue scale (VAS) and quality of life (QoL) scores and frequencies of diurnal and nocturnal urination were evaluated and compared at baseline and at 1, 3 and 6 months after injection and also were compared between the two groups.

RESULTS: A total of 60 consecutive patients were randomized to a BoNT-A (treatment) or normal saline (placebo) group. In the treatment group at the 1-, 3- and 6-month evaluation the NIH-CPSI total and subscale scores, and the AUA-SS, VAS and QoL scores, along with frequencies of diurnal and nocturnal urinations, had significantly improved compared with baseline values (P < 0.05). By contrast, in the placebo group, none of these values showed improvement and the values were significantly different from those in the treatment group. Although the differences between the two groups in AUA-SS and frequencies of nocturnal urination were not significant at 1-month follow-up, repeated-measure analysis showed significant improvement in each of these values over the entire follow-up period in the treatment group. The most prominent improvement was related to the pain subscale score, which decreased by 64.76, 75.63 and 79.97% at 1, 3 and 6 months after treatment compared with baseline, followed by the VAS score, which decreased by 62.3, 72.4 and 82.1% at each follow-up, respectively. Only two patients developed mild transient gross haematuria, which was managed conservatively.

CONCLUSIONS: Transurethral intraprostatic BoNT-A injection maybe an effective therapeutic option in patients with CP/CPPS as it reduces pain and improves QoL.
Age: 37 | Onset Age: 30 (May 2010) | Symptoms: Pain, Itching, Burning, Shooting Pain Sometimes, throbbing, in Perineum, Scrotum, Sphincter, Coccyx, Lumbar, Sacral, ED, Reduced Libido, | Helped By:Headache in the Pelvis, Internal PT, External PT, Gluten Diet, Relaxation, Vacation, | Worsened By:Stress/Anxiety/Suspense, Gluten Alcoholic Drink, Tadalafil, Viagra, Sexual Excitement or Arousal, Pelvic Floor Muscles Clenching| Other comments: Nerves Block (Ganglion Impar, Iliohypogastric, Ilioinguinal, Genitofemoral, Pudendal Nerve block with no effect, Quercetin, Pollen Aid, with Limited Effect, My Story is here : http://www.ucpps.men/forum ... =37&t=8634
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Re: Transurethral intraprostatic injection of Botulinum A for CPPS

Post by webslave »

Full study here: http://onlinelibrary.wiley.com/doi/10.1 ... 12951/full

Looks interesting. It makes sense that relaxing smooth muscles and nerves in the prostate could alleviate pain in many men. Once prostatitic pain is subdued, any responsive spasm in pelvic muscles may subside, thus further reducing prostate inflammation, and so on, self-reinforcing negative feedbacks unwinding the situation.
Full study discussion section wrote:A suppressive effect of [Botox] on smooth muscle tone and sensory neurons, along with atrophy of the prostate gland induced by intraprostatic injection of [Botox], may be important mechanisms in relieving [symptoms]
It could be a way of short-circuiting the vicious cycle of pain and spasm that can feature in CPPS.
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Chriss
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Transurethral Botox Injection vs Transrectal Botox Injection

Post by Chriss »

Hi Friends
waiting for your comments :
Full Text is here;
http://www.sciencedirect.com/science/ar ... 8X15000054
Intraprostatic injection of botulinum toxin-A in patients with refractory chronic pelvic pain syndrome: The transurethral vs. transrectal approach

Objective
To evaluate the outcome of an intraprostatic injection of botulinum toxin-A (BTX-A) in men with refractory chronic prostatitis-associated chronic pelvic-pain syndrome (CP/CPPS) and to compare the efficacy of the transurethral and transrectal routes.

Patients and methods
In an uncontrolled randomised clinical trial conducted in men with refractory CP/CPPS, the patients were classified into two groups according to the route of BTX-A injection; transurethral (group 1, 28 patients) and transrectal ultrasonography-guided (group 2, 35 patients). The chronic prostatitis symptom index (CPSI), maximum urinary flow rate (Qmax) and white blood cell (WBC) count in expressed prostatic secretion (EPS) were measured before and at 3, 6 and 12 months after the injection. A significant clinical improvement (SCI, defined as a reduction of 4 points or a 25% decrease in total CPSI score) was correlated with patient age, prostate volume and symptom duration.

Results
In group 1, the pain and quality-of-life domain scores improved, but statistically significantly only at 6 months. The voiding score improved at all follow-up visits. In group 2 there was a significant improvement in all the CPSI domain scores at all follow-up visits, except for pain, which was insignificantly improved by 12 months. The SCI ratings in groups 1 and 2 were 36%, 79% and 57%, and 49%, 89% and 74% in group 2 at the three follow-up visits, respectively. The Qmax was significantly improved in both groups during the follow-up (except at 12 months in group 1). There was a significant reduction in the mean WBC count in the EPS in patients with inflammatory prostatitis. Both prostate volume and symptom duration were significantly associated with a lower SCI rating.

Conclusion
BTX-A is an available treatment option for patients with refractory CP/CPPS. It is more effective in patients with a small prostate and short symptom duration. The transrectal route provided better results than the transurethral route. More prospective longer term studies are needed.

Abbreviations
BTX-A, botulinum toxin type A;
CP/CPPS, chronic prostatitis associated with chronic pelvic pain syndrome;
NIH, National Institutes of Health;
CPSI, chronic prostatitis symptom index;
Qmax, maximum urinary flow rate;
WBC, white blood cell;
EPS, expressed prostatic secretion;
SCI, satisfactory clinical improvement;
QoL, quality of life;
HPF, high-power field
89% Improvements seems very encouraging !
are you agree for Botox injection (transrectal or transurethral) ???
Age: 37 | Onset Age: 30 (May 2010) | Symptoms: Pain, Itching, Burning, Shooting Pain Sometimes, throbbing, in Perineum, Scrotum, Sphincter, Coccyx, Lumbar, Sacral, ED, Reduced Libido, | Helped By:Headache in the Pelvis, Internal PT, External PT, Gluten Diet, Relaxation, Vacation, | Worsened By:Stress/Anxiety/Suspense, Gluten Alcoholic Drink, Tadalafil, Viagra, Sexual Excitement or Arousal, Pelvic Floor Muscles Clenching| Other comments: Nerves Block (Ganglion Impar, Iliohypogastric, Ilioinguinal, Genitofemoral, Pudendal Nerve block with no effect, Quercetin, Pollen Aid, with Limited Effect, My Story is here : http://www.ucpps.men/forum ... =37&t=8634
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Re: Transurethral intraprostatic injection of Botulinum A for CPPS

Post by webslave »

NO improvement in pain though.
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