Efficacy of transurethral botulinum toxin A injections for bladder outlet obstruction: A systematic review and meta-analysis

Filippo Gavi; Mauro Ragonese; Daniele Fettucciari; Riccardo Bientinesi; Carlo Gandi; Marco Campetella; Filippo Marino; Marco Racioppi; Emilio Sacco; Nazario Foschi

doi:10.1177/03915603241228166

Efficacy of transurethral botulinum toxin A injections for bladder outlet obstruction: A systematic review and meta-analysis

Urologia. 2024 Feb 19:3915603241228166. doi: 10.1177/03915603241228166. Online ahead of print.

Authors

Filippo Gavi^{1

2}, Mauro Ragonese², Daniele Fettucciari^{1

2}, Riccardo Bientinesi³, Carlo Gandi², Marco Campetella⁴, Filippo Marino^{1

2}, Marco Racioppi³, Emilio Sacco⁴, Nazario Foschi²

Affiliations

¹ Postgraduate School of Urology, Università Cattolica del Sacro Cuore, Rome, Italy.
² Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
³ Department of Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University of Sacred Heart, Rome, Italy.
⁴ Urology Department, Isola Tiberina-Gemelli Isola Hospital, Catholic University Medical School, Rome, Italy.

PMID: 38372240
DOI: 10.1177/03915603241228166

Abstract

Introduction: Botulinum toxin A (BoNT-A) injections in the prostate gland have been used as a minimally invasive option for treating bladder outlet obstruction (BOO). However, the efficacy of transurethral BoNT-A injections for BOO is not well established in the literature. The aim of this study is to collect evidence on the efficacy of transurethral BoNT-A injections for the treatment of BOO.

Materials and methods: This systematic review and meta-analyses was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A systematic literature search was performed till December 2022. The study population consisted of adult patients diagnosed with BOO, who underwent transurethral injections of BoNT-A for the treatment of BOO.

Evidence synthesis: Out of 883 records, we identified seven studies enrolling 232 participants, of which only one nonrandomized controlled trial was found. Four prospective studies and two retrospective studies. Three studies included patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) and were included in the meta-analysis. Three studies included patients with urethral sphincter hyperactivity. One study included patients with primary bladder neck disease (PBND). All studies showed significant improvements from baseline in maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR) at 3 and 6 months. The adverse events were mild in all studies. Hematuria, UTI, and urinary retention were reported across all studies.

Conclusion: In conclusion, transurethral BoNT-A injections have been shown to improve LUTS, QoL, and urodynamic parameters of individuals with BOO at 3 and 6 months after injections, and no serious adverse effects have been reported. However, data on the long-term benefits of this treatment are scarce, and more prospective, randomized studies with larger samples examining various injection techniques, dosages, and extended follow-up of recurrent injections are needed.

Keywords: BPH; Bladder outlet obstruction; bladder neck disease; botulinum; meta-analysis.

Publication types

Review