Intraprostatic injection of botulinum toxin type-A relieves bladder outlet obstruction in human and induces prostate apoptosis in dogs

BMC Urol. 2006 Apr 18:6:12. doi: 10.1186/1471-2490-6-12.


Background: With the increasing interest with botulinum toxin--A (BTX-A) application in the lower urinary tract, we investigated the BTX-A effects on the canine prostate and also in men with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH).

Methods: Transperineal injection into the prostate using transrectal ultrasound (TRUS) was performed throughout the study. Saline with or without 100 U of BTX-A was injected into mongrel dogs prostate. One or 3 months later, the prostate was harvested for morphologic and apoptotic study. In addition, eight BPH patients refractory to alpha-blockers were treated with ultrasound guided intraprostatic injection of 200 U of BTX-A.

Results: In the BTX-A treated dogs, atrophy and diffuse apoptosis was observed with H&E stain and TUNEL stain at 1 and 3 months. Clinically, the mean prostate volume, symptom score, and quality of life index were significantly reduced by 18.8%, 73.1%, and 61.5% respectively. Maximal flow rate significantly increased by 72.0%.

Conclusion: Intraprostatic BTX-A injection induces prostate apotosis in dogs and relieves BOO in humans. It is therefore a promising alternative treatment for refractory BOO due to BPH.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Animals
  • Apoptosis
  • Atrophy
  • Botulinum Toxins, Type A / administration & dosage*
  • Dogs
  • Humans
  • In Situ Nick-End Labeling
  • Injections
  • Male
  • Neuromuscular Agents / administration & dosage*
  • Prostate / drug effects*
  • Prostate / pathology
  • Prostatic Hyperplasia / complications
  • Ultrasonography, Interventional
  • Urinary Bladder Neck Obstruction / drug therapy*
  • Urinary Bladder Neck Obstruction / etiology
  • Urinary Bladder Neck Obstruction / pathology


  • Neuromuscular Agents
  • Botulinum Toxins, Type A