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Botox Is No Better Than Placebo for BPH-Associated Urinary Symptoms

Summary and Comment |
July 22, 2014

Botox Is No Better Than Placebo for BPH-Associated Urinary Symptoms

  1. Allan S. Brett, MD

About 60% of men in both groups reported fewer symptoms of benign prostatic hyperplasia after intraprostatic injections.

  1. Allan S. Brett, MD

Bladder injections of onabotulinumtoxinA (Botox) are FDA approved for two urinary indications — urge incontinence in patients with overactive bladder who cannot tolerate or do not respond adequately to anticholinergic drugs, and urinary incontinence caused by detrusor overactivity in patients with neurological conditions such as multiple sclerosis or spinal cord injury. Researchers sought to determine whether botulinum toxin might also improve lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH).

In an industry-sponsored, double-blind trial, 315 men with moderate-to-severe BPH symptoms (after withdrawal of previous treatment with α-blockers or 5α-reductase inhibitors) were randomized to receive intraprostatic injections of onabotulinumtoxinA or placebo. During 12 weeks of follow-up, about 60% of patients in both the botulinum-toxin and placebo groups responded (i.e., their symptom scores decreased from baseline by ≥4 points on a 35-point scale), with no difference between groups in mean scores or response rates.

Comment

This study demonstrates convincingly that botulinum-toxin injections should not be used to treat patients' lower urinary tract symptoms associated with BPH. The placebo response in this study was remarkable.

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (1)

JOHN AMATO Other Healthcare Professional, Hospital Medicine

It has been shown that NS injections can numb due to the effect, localized, on nerve reception. If in fact an injection of NS was used, then this could have a physiological effect that has not been accounted for.

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