Botox in CPPS

[victorspain]

European Urology





Vol. 38, No. 4, 2000
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Free Abstract Article (Fulltext) Article (PDF 251 KB)

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Prostate Cancer

Perisphincteric Injection of Botulinum Toxin Type A
A Treatment Option for Patients with Chronic Prostatic Pain?
Dirk-Henrik Zermanna,b, Manabu Ishigookaa,c, Jörg Schubertb, Richard A. Schmidta

aNeurourology Unit, Department of Urology, University of Colorado Health Science Center, Denver, Colo., USA;
bDepartment of Urology, University Hospital, Friedrich Schiller University, Jena, Germany; and
cDepartment of Urology, Yamagata University Medical School, Yamagata, Japan


Address of Corresponding Author

European Urology 2000;38:393-399 (DOI: 10.1159/000020314)


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Key Words

Chronic prostatic pain
Pelvic floor muscle dysfunction
Botulinum toxin type A
Urodynamics

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Abstract

Background: Chronic prostatic pain is still a diagnostic and therapeutic problem. The clinical observation that prostatic and pelvic pain is accompanied by motoric and sensoric disorders of the pelvic floor muscles led to the hypothesis that prostatic pain roots in a changed processing of afferent and efferent information with the central nervous system (CNS).

Methods: Neuro-urological work-up of 11 male patients with chronic prostatic pain was completed. This included a clinical evaluation of pelvic floor function, urodynamic investigation of bladder and urethra function and a cystoscopy to exclude morphological aberrations. A transurethral perisphincteric injection of 200 units botulinum toxin type A (BTX) was followed by a 2- to 4-week visit to evaluate their influence on the neuro-urological symptomatology.

Results: All chronic prostatic pain patients suffered from a pathological pelvic floor tenderness, an inability of sufficient conscious pelvic floor control, a urethral hypersensitivity/hyperalgesia and a urethral muscle hyperactivity. Basic parameters of bladder function (capacity, sensitivity, compliance) were normal. The BTX injection was followed by a pelvic floor muscle weakening and a relief of prostatic pain and urethral hypersensitivity/hyperalgesia. A botulinum-related decrease of the functional urethral length, the urethral sphincter closure pressure, the postvoid residual volume and an increase of the peak and average uroflow were objectivated.

Conclusion: A weakening of the urethral sphincter muscle via blocking acetylcholine release by BTX injection is followed by pain relief and symptom improvement. It can therefore be concluded that a barrage of nociceptive information from the dysfunctional pelvic floor overflood the CNS and induce a changed CNS processing. Interrupting the efferent branch of the disturbed central circle is one opportunity to treat chronic prostatic pain.


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Author Contacts

Dr. med. Dirk-Henrik Zermann
Department of Urology, University Hospital
Friedrich Schiller University Jena, D-07740 Jena (Germany)
Tel. +49 (3641) 935 201, Fax +49 (3641) 935 003
E-Mail [email protected]


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Article Information

Accepted after revision: February 16, 2000
Number of Print Pages : 7
Number of Figures : 2, Number of Tables : 3, Number of References : 48


Free Abstract Article (Fulltext) Article (PDF 251 KB)

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