Efficacy of botulinum toxin-A injection versus oral anticholinergic medications following transurethral resection of the prostate to manage bladder outlet obstruction with overactive bladder: a prospective randomized clinical trial study.

Background: To compare the effect of botulinum toxin-A (BoNT-A) injection versus oral anticholinergic agents following transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and Overactive Bladder.

Materials and methods: In this randomized clinical trial from February 2021 till May 2022 data of patients with obstructive urinary symptoms and urgency incontinence were analyzed. The intervention group consisted of 35 patients who were injected with 300 units of BoNT-A (Dysport^®) into the detrusor muscles at the same time as TURP. 38 participants in the control group were treated with solifenacin 5 mg (Urinacin^®) daily after TURP.

Results: In the evaluation of 73 included patients (mean age: 67.54±6.3), IPSS score change (first month, P=0.777; 6^th month, P=0.761) and storage irritative symptoms change score (first month, P=0.995; 6^th month, P=0.962) were decreased and Qmax was increased (first month, P=0.195; 6^th month, P=0.174) similarly in 2 groups. Lower number of patients experienced urgency incontinence during follow up time in intervention group, significantly (first month, 18 versus 5, P=0.002; 6^th month, 20 versus 6, P=0.002). PVR was also decreased more in first month and 6^th month follow up in patients of intervention group (1^th month, P=0.012; 6^th month, P=0.033).

Conclusion: Anticholinergic agents or intradetrusor BoNT-A injection would improve the storage symptoms in patients with BPH and detrusor overactivity following TURP. In contrast to IPSS score, storage irritative score and Qmax, which improve similarly in both groups, the PVR and urgency incontinence episodes will improve more in patients receive intradetrusor BoNT-A injection.