Botulinum toxin in prostate diseases
The medical application of these most toxic natural substance was presented at the German Association of Urology congress in 2007, particularly the recent developments in the use of bacteria Gifts to the prostate.Botulinum toxins (from Latin botulus = sausage, toxin = poison) are formed by the bacterium Clostridium botulinum and the "self-defense" released into the environment. We distinguish seven types (A to G), five of them (all except C and D) are highly dangerous to humans, the most effective naturally occurring poison: Even less than a millionth of a gram can be fatal. It can occur in contaminated food (eg in sausage, meat, vegetables), but is destroyed by heating (eg cooking in about 10 minutes).
For poisoning usually occur by the supply of heated insufficient food, ie by a bacterial food poisoning. It is called botulism ("sausage poisoning") and is rare. After hours to a few days occur mainly on paralysis (eg, double vision, slurred speech, difficulty swallowing, shortness of breath) caused by a persistent impairment of nerve fibers. Because of this effect is also called botulinum neurotoxin (BoNT).
Use of botulinum toxin for the treatment
For more than 20 years makes you look in medicine, the effect of botulinum neurotoxin advantage, particularly of the type A (BoNT / A). It is used in extreme dilution, particularly around tense muscles to paralyze (eg torticollis) or the excessive secretion of body fluids contain (eg pathological sweating); these effects hold for months. But best known is certainly the use of the face as a "wrinkle killer".
Only in recent years, the use of options to be explored in urology. An admission there is not yet, not even in prostate diseases. Most likely it is done soon overactive bladder, a form of bladder dysfunction, wherein the overactivity of the bladder muscle for involuntary urine loss results (see also urinary incontinence ).
Botulinum toxin in the BPS
The use of botulinum neurotoxin in the benign prostatic syndrome ( BPS , benign prostate enlargement) has made headlines in recent months: "syringes instead of cutting" and "injection instead of surgery" promised if it were a real alternative. Quite so but it is not, at least not yet:
When it comes BPS because of the enlargement of the prostate in a narrowing (obstruction) of the urethra is so attenuated as the urine and the bladder can not be emptied completely (residual urine; see also characters and complications of the BPS ). Are injected now botulinum neurotoxin directly into the prostate increases, so in most men the maximum urinary flow rate, while the complaints (measured as IPSS value) and the residual urine volume decrease and prostate volume and thus the PSA level decline (see also study the BPS and PSA testing ).
The injection is straightforward and is usually done under local anesthetic under ultrasound guidance from the dam from (transperineal), through the urethra (transurethral) or through the rectum (transrectal). The effect is seen after one to four weeks, and lasts up to a year. Adverse effects have not been observed, no urinary incontinence (involuntary loss of urine) or erectile dysfunction ("impotence").
As the effect is exactly about, could not be clarified in the few existing studies so far. The reduction of the prostate goes back to atrophy (degeneration) of the fabric, in many but not all cases, to the initiation of programmed cell death (apoptosis). The improvement of the signs and symptoms seem to be independent of it.
In addition, many important questions remain unanswered, for example: Which patients the method ever comes into question? As the PSA waste affects the utility of PSA in the early detection of cancer? What effect does the lesion to the detection of prostate cancer in a possible biopsy? Do these changes again back completely? After which time a repeat of botulinum toxin administration is necessary? How often the injection can be repeated?
These questions need to be answered in future, larger studies. The results so far do hope, however. After the injection of botulinum neurotoxin in the prostate at the BPS seems to be a simple, gentle and effective (but expensive) method. You might come primarily in consideration if a surgical treatment should be postponed or not desired or not possible (see also surgical procedure for BPH treatment ).
Botulinum toxin in prostatitis
We investigated so far only the use of botulinum toxin in chronic abacterial prostatitis (not caused by germs prostatitis, special form of prostatopathy ). For this there are initial studies, although to some small number of cases and conflicting results. Therefore, further studies remain to be seen before an assessment is possible.
Conclusion
Botulinum neurotoxin is not yet approved in urology. Studies on its use in prostatitis are still at the beginning. In contrast, its application is true when BPS as promising and innovative: As a minimally invasive (less engaging) method could help it continue to postpone surgery or even avoid. Until the completion of major studies and the presence of long-term results but - as always with new methods - caution should be exercised.
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