Federico Guercini MD
Control/Tracking Number : 05-AB-5291-AUA
Activity: Paper Submission
Current Date/Time : 10/16/2004 12:59:34 PM
DOES INTRAPROSTATIC INJECTION OF BOTULIN TOXIN RELIEVES SYMPTOMS OF THE CHRONIC PELVIC PAIN SYNDROME(CPPS)? A MULTICENTER PILOT STUDY
Federico Guercini*, Antonella Giannantoni, Rome, Italy; Robert L Bard, New York, NY; Giuseppe Brisinda, Federica Cadeddu, Paolo Rosi, Cinzia Pajoncini, Massimo Porena, Rome, Italy
Introduction and Objective:
Experimental data and observations in animal models support the hypothesis that botulinum-A toxin (BTX-A) has antinociceptive effects that are independent of its actions on the neuromuscular junction. Intravescical BTX-A administration improved symptoms in patients with refractory interstitial cystitis. Furthermore, it has been noted that a weakening of the urethral sphincter muscle by BTX-A injection is followed by pain relief and symptoms improvement. As CPPS-related pain is refractory to all therapy in many patients and as the pain trigger zone appears to be within the prostate we decided to attempt treatment with BTX-A intraprostatic infiltrations in patients affected by chronic abacterial prostatitis/CPPS with severe pain.
Methods:
10 men affected by chronic prostatitis / chronic pelvic pain syndrome were enrolled in the study which was approved by the Perugia University Ethics Committee. Inclusion criteria were severe pain during DRE, NIH Chronic Prostatitis Symptoms Index (NIH-CPSI) score >30, lack of response to all pain killer treatment, no detectable bacteria in urine and sperm samples. Exclusion criteria were bacterial prostatitis, prostate weight >40 grams, prostate cancer. Before treatment, patients underwent TRUS with uroflowmetry, routine culture tests on sperm and urine samples and PSAt dosing. They also completed the NIH-CPSI. After patients had provided informed consent, 150 U of BTX-A diluted in 2.5cc saline solution was infiltrated into each of their two prostatic lobes, by ultrasound-guided injection. After 1 and 3 months’ follow-up patients repeated the pre-injection work-up. Data were analysed using the analysis of variance for repeated measures.
Results:
The mean age of patients was 37 years (28-46).
BASELINE 1 MONTH 3 MONTHS p
NIH-CPPS 34 17 16 0.05
Prostate weight gr. 32 22 21 0.05
Peak Urine flow ml/sec 16 20 20 0.05
PSAt ngr/ml 8.3 3.9 1.7 0.05
No complications or side effects were reported during the follow-up period.
Conclusions:
Despite the few patients enrolled in this study and the brief follow-up this pilot study has shown BTX-A intraprostatic injection is a valid approach in patients with chronic prostatitis / chronic pelvic pain syndrome and high or even very high NIH CPSI scores.
Author Disclosure Block: F. Guercini, None; A. Giannantoni, None; R.L. Bard, None; G. Brisinda, None; F. Cadeddu, None; P. Rosi, None; C. Pajoncini, None; M. Porena, None.
Source of Funding: None
Status: Complete
