Transperineal Botulinum Toxin Injection for Chronic Pelvic Pain Syndrome after Transurethral Resection of the Prostate
Vol. 19 No. 04 (2022),
11 September 2022
Purpose: To evaluate the efficacy of botulinum toxin type A (BTX-A) injection in patients with chronic pelvic pain syndrome (CPPS) after transurethral resection of the prostate (TURP).
Materials and Methods: Six patients after TURP received the injection of BTX-A around the prostate capsule or pelvic floor under ultrasound guidance. The clinical outcomes including overall pain intensity (assessed by visual analog scale, VAS), the Functional Pelvic Pain scale (FPPS), and mental state by anxiety and depression questionnaires, the generalized anxiety disorder (GAD-7) and Hamilton depression rating scale (HAM-D)) were assessed at pre-treatment, and 1, 4, 12 weeks after treatment.
Results: Six male patients, aged 65 to 76 years were enrolled. The improvement of VAS pain score, the Functional Pelvic Pain scale, and mental assessment were observed at 1, 4, and 12 weeks after treatment for all six patients. All 6 patients had no safety concerns through 12 weeks visit, except 3 patients complained transient pain at injection site.
Conclusion: Injection of BTX-A around the prostate under ultrasound guidance may be effective and safe for patients with CPPS after TURP.
- chronic pelvic pain syndrome; botulinum toxin; injection
How to Cite
EAU guidelines on chronic pelvic pain [https://uroweb.org/guideline/chronic-pelvic-pain/].
Zhang R, Sutcliffe S, Giovannucci E, et al. Lifestyle and Risk of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in a Cohort of United States Male Health Professionals. J Urol. 2015;194:1295-1300.
Nickel JC. Treatment of chronic prostatitis/chronic pelvic pain syndrome. Int J Antimicrob Agents. 2008;31:S112-6.
Cheshire WP, Abashian SW, Mann DJ. Botulinum toxin in the treatment of myofascial pain syndrome. Pain. 1994;59:65-9.
Bhide AA, Puccini F, Khullar V, Elneil S, Digesu GA. Botulinum neurotoxin type A injection of the pelvic floor muscle in pain due to spasticity: a review of the current literature. Int Urogynecol J. 2013;24:1429-34.
Halder GE, Scott L, Wyman A, et al. Botox combined with myofascial release physical therapy as a treatment for myofascial pelvic pain. Investig Clin Urol. 2017;58:134-9.
Smith CP, Radziszewski P, Borkowski A, Somogyi GT, Boone TB, Chancellor MB. Botulinum toxin a has antinociceptive effects in treating interstitial cystitis. Urology. 2004;64:871-5.
Gottsch HP, Yang CC, Berger RE. A pilot study of botulinum toxin A for male chronic pelvic pain syndrome. Scand J Urol Nephrol. 2011;45:72-6.
Falahatkar S, Shahab E, Gholamjani Moghaddam K, Kazemnezhad E. Transurethral intraprostatic injection of botulinum neurotoxin type A for the treatment of chronic prostatitis/chronic pelvic pain syndrome: results of a prospective pilot double-blind and randomized placebo-controlled study. BJU Int. 2015;116:641-9.
Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod Update. 2001;7:567-76.
Smart CJ, Jenkins JD, Lloyd RS. The painful prostate. Br J Urol. 1975; 47:861-9.
Smith HS, Audette J, Royal MA. Botulinum toxin in pain management of soft tissue syndromes. Clin J Pain. 2002; 18:S147-54.
Zermann D, Ishigooka M, Schubert J, Schmidt RA. Perisphincteric injection of botulinum toxin type A. A treatment option for patients with chronic prostatic pain? Eur Urol. 2000; 38:393-9.
El-Enen MA, Abou-Farha M, El-Abd A, et al. Intraprostatic injection of botulinum toxin-A in patients with refractory chronic pelvic pain syndrome: The transurethral vs. transrectal approach. Arab J Urol. 2015;13:94-9.
Coelho A, Dinis P, Pinto R, et al. Distribution of the high-affinity binding site and intracellular target of botulinum toxin type A in the human bladder. Eur Urol. 2010;57:884-90.
Chuang YC, Yoshimura N, Huang CC, Wu M, Chiang PH, Chancellor MB. Intraprostatic botulinum toxin a injection inhibits cyclooxygenase-2 expression and suppresses prostatic pain on capsaicin induced prostatitis model in rat. J Urol. 2008;180:742-8.
Aoki KR. Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology. 2005;26:785-93.
Morrissey D, El-Khawand D, Ginzburg N, Wehbe S, O'Hare P 3rd, Whitmore K. Botulinum Toxin A Injections Into Pelvic Floor Muscles Under Electromyographic Guidance for Women With Refractory High-Tone Pelvic Floor Dysfunction: A 6-Month Prospective Pilot Study. Female Pelvic Med Reconstr Surg. 2015;21:277-82.
- Abstract Viewed: 37 times
- 7128/pdf Downloaded: 33 times