Treatment of lower urinary tract symptoms: Agents for intraprostatic injection
Institute of Regenerative Medicine, Wake Forest University School of Medicine, and Department of Urology, Wake Forest Baptist Medical Center , Winston Salem, NC , USA.Scandinavian Journal of Urology (Impact Factor: 1.25). 01/2013; 47(2). DOI: 10.3109/00365599.2012.752404
Abstract When the currently available pharmacotherapeutic principles used for treatment of male lower urinary tract symptoms (LUTS) fail, transurethral resection of the prostate still remains the widely applied gold-standard therapy, since the majority of minimally invasive therapies have not achieved the same efficacy and/or lack an evidence base to support their routine use. Intraprostatic injection therapy, which probably is the oldest minimally invasive surgical treatment, has not been widely used, but recent reports of successful treatments with several new agents have renewed interest in this approach. Anhydrous ethanol still seems to be one of the most extensively studied injectables to date, but intraprostatic injection of botulinum toxin has received much recent attention, with regard to both its mechanism of action and efficacy. In addition, other agents such as NX-1207 and PRX302 have been reported to have promising effects. Injection therapy, using the transperineal, transrectal and transurethral routes for delivery of the active compounds, seems to be an effective minimally invasive surgical therapy for LUTS associated with benign prostatic hyperplasia (BPH). However, further studies on mechanisms of action of the novel agents used, and controlled clinical trials documenting their efficacy and side-effects (which are largely lacking), are needed before their place in the treatment of BPH/LUTS can be properly assessed.
Article: Drugs for urethra[Show abstract] [Hide abstract]
ABSTRACT: To describe drugs targeting urethra and prostate to treat dysfunctions such LUTS related to BPH, primary bladder neck obstruction (PBNO), detrusor sphincter dyssynergia (DSD) or sphincter deficiency (SD). Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies web sites (HAS and ANSM). To treat LUTS related to BPH alpha-blockers (AB) and 5-alpha reductase inhibitors (5ARIs) have a clearer efficacy than plant extract. Daily Phospdiesterase 5 inhibitors (PDE5Is) alone or in association with AB also demonstrate efficacy in this indication. AB are an option in PBNO and DSD related to multiple sclerosis. Although Botulinum toxin A derived molecules decrease urethral pressure in patient with DSD related to spinal cord injury or multiple sclerosis, efficiency remains to be demonstrated. Duloxetine a serotonin reuptake inhibitor increases urethral sphincter pressure and reduce stress urinary incontinence in women and men. Nevertheless, moderate efficacy combine with frequent side effects lead French regulation agency to reject its agreement. Armamenterium to treat urethral dysfunctions has recently increases. Two new therapeutic classes emerge: PDE5Is to treat LUTS related to BPH and an SRIs (Duloxetine) to treat stress urinary incontinence. Efficacy and safety evaluation of all the possible associations between drugs targeting urethra and/or bladder is needed to a subtler and more efficient pharmacologic modulation of lower urinary tract dysfunction.Progrès en Urologie 11/2013; 23(15):1287-98. DOI:10.1016/j.purol.2013.09.007 · 0.66 Impact Factor
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ABSTRACT: There continues to be a strong interest in the novel minimally invasive therapies for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). There has been an emergence of new approaches, particularly with mechanical approaches such as the Urolift and new agents suitable for intraprostatic injection. Our purpose is to review the recent literature regarding the safety and efficacy of these therapies, and introduce a number of promising experimental therapies. The Urolift device has shown safety and efficacy for BPH treatment in phase III clinical trials, with the advantage of a local anaesthetic outpatient procedure, no catheter, and no sexual dysfunction. Intraprostatic injection of botulinum toxin or ethanol has provided mixed results and need further well designed studies. NX-1207 and PRX302 are newer injectable agents under clinical trial. Several novel therapies such as Rezum, Histotripsy, and Aquablation have no published efficacy and safety data available. Urolift appears to be a well tolerated and effective minimally invasive treatment for lower urinary tract symptoms due to BPH in men who wish to preserve sexual function or who are not suitable for invasive surgery. Further studies will confirm the currently mixed results regarding intraprostatic botulinum toxin or ethanol injections. Rezum, Histotripsy, and Aquablation are experimental treatments under investigation.Current opinion in urology 11/2013; 24(1). DOI:10.1097/MOU.0000000000000006 · 2.33 Impact Factor
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ABSTRACT: Transurethral dilatation of the prostate (TUDP) with a spherical balloon catheter is a traditional treatment to benign prostatic hyperplasia (BPH) patients. However, TUDP has been abandoned in clinical application because of its unsatisfying treatment benefit and severe complications. In this study, we redesigned an improved TUDP surgery, named transurethral split of the prostate (TUSP), by replacing the spherical balloon with a columnar balloon. To evaluate the clinical therapeutic effect, we compared the lower urinary tract symptoms (LUTS) of BPH patients after TUSP treatment and analyzed the urethra through CT films. Animal experiments were performed on aged dogs to investigate the urine function and electromyography (EMG) changes. Histopathology was used to evaluate the inflammation and injury. Additionally, collagen content was detected by Trichrome Masson. TUSP attenuated LUTS and reconstructed urethra in BPH patients. The attenuation of LUTS was reflected in terms of LUTS parameters such as Qmax, post-void residual urine volume (PVR), quality of life (QOL) score and International Prostate Symptom Score (IPSS). TUSP expanded the urethra in experimental dogs by splitting the prostate tissues and decreasing the collagen content, with maintenance of normal urinary function and EMG characteristics. The successful clinical application of TUSP with significant therapeutic effect and limited complications made TUSP an ideal choice for the BPH patients.Journal of endourology / Endourological Society 10/2014; 29(3). DOI:10.1089/end.2014.0207 · 1.71 Impact Factor
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