Intraprostatic botulinum toxin type A administration: evaluation of the effects on sexual function

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Study Type – Therapy (case series)Level of Evidence 4What’s known on the subject? and What does the study add?Intraprostatic injection of botulinum toxin type A was shown to be effective in decreasing symptoms of BPH in several recent studies. However, the possible impairment of sexual function caused by the neurotoxin had never been investigated.This study shows that intraprostatic administration of botulinum toxin type A neither causes deterioration of sexual function (libido, orgasm, erectile function or ejaculation), nor alteration of serum testosterone levels.OBJECTIVE•To evaluate the consequences on male sexual function of intraprostatic injection of botulinum toxin type A (BoNT/A) as a treatment for benign prostatic hyperplasia (BPH). Although BoNT/A is effective in decreasing symptoms of BPH, neuronal impairment caused by the neurotoxin might affect emission/ejaculation. These aspects have not been evaluated before.PATIENTS AND METHODS•In all, 16 sexually active men aged >60 years with BPH/benign prostatic enlargement (BPE), International Prostate Symptom Score (IPSS) ≥8 and a maximum urinary flow rate (Qmax) <15 mL/s refractory to standard medical therapy volunteered for the study.•Patients were injected transrectally, under ultrasonographic control, with 200 U of BoNT/A in the prostate. Evaluation was carried out at baseline and 1, 3 and 6 months post-treatment. Erectile function was evaluated using the International Index of Erectile Function – Short Form (IIEF-5) questionnaire.•Orgasmic/ejaculatory function and libido were evaluated using questions 9, 10, 11 and 12 of the IIEF – Long Form. Total testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin were also investigated.RESULTS•The mean age was 73 ± 6 years. The IIEF-5 score was 16.5 ± 6 at baseline, 15.7 ± 6 at 1 month, 16.6 ± 6 at 3 months and 15.7 ± 5 at 6 months (differences nonsignificant).•The score for ejaculatory/orgasmic function (questions 9 and 10) remained fairly constant from baseline to the sixth month, 8.3 ± 1.9 and 8 ± 2.1 respectively.•The sexual desire score (questions 11 and 12 of the IIEF) also remained little changed from baseline (5.9 ± 1.6) to month 6 (6.1 ± 2). Total serum testosterone, LH, FSH and prolactin did not change during the study.CONCLUSIONS•Intraprostatic injection of BoNT/A in patients with BPE does not impair erectile, orgasmic or ejaculatory functions and does not change libido.•The male hormonal profile is not altered by BoNT/A injection. This facilitates the acceptance of BoNT/A as a treatment for BPH/BPE lower urinary tract symptoms (LUTS) refractory to standard medical management.

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