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
Source: PubMed


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.

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    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.
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