Botulinum Toxin Type A for the Treatment of Male Chronic Pelvic Pain Syndrome - Full Text View

Sponsor:	Cantonal Hospital of St. Gallen
Collaborator:	Allergan
Information provided by:	Cantonal Hospital of St. Gallen
ClinicalTrials.gov Identifier:	NCT00464373

Purpose

The aim of this randomized placebo-controlled study is to demonstrate the efficiency and safety of the injection of Botulinum Toxin Type A (200 Units) into the external urethral sphincter for the treatment of chronic prostatitis/chronic pelvic pain.

Condition	Intervention	Phase
Chronic Prostatitis With Chronic Pelvic Pain Syndrome Prostatitis	Drug: Botulinum Toxin Type A Drug: Placebo	Phase III

Study Type:	Interventional
Study Design:	Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Placebo Control, Parallel Assignment, Efficacy Study
Official Title:	Injection of Botulinum Toxin Type A Into the External Urethral Sphincter for Male Patients Suffering From Chronic Prostatitis/Chronic Pelvic Pain Syndrome (NIH Cat. III): a Prospective, Double-Blind and Placebo-Controlled Clinical Trial

Resource links provided by NLM:

MedlinePlus related topics: Botox Pelvic Pain

Drug Information available for: Clostridium botulinum toxin

U.S. FDA Resources

Further study details as provided by Cantonal Hospital of St. Gallen:

Primary Outcome Measures:

NIH-CPSI Total Score [ Time Frame: 1 year ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

NIH-CPSI Subscales [ Time Frame: 1 year ] [ Designated as safety issue: No ]
Standardized questions for the assessment of the treatment outcome [ Time Frame: 1 year ] [ Designated as safety issue: No ]
International prostate symptom score (I-PSS) [ Time Frame: 1 year ] [ Designated as safety issue: No ]

Estimated Enrollment:	60
Study Start Date:	April 2007
Estimated Study Completion Date:	April 2010
Estimated Primary Completion Date:	April 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
1: Experimental Botulinum Toxin Type A 200 U in 4ml NaCl 0.9%	Drug: Botulinum Toxin Type A Single intrasphincteric injection at the 3,6,9, and 12 o'clock positions of the external urethral sphincter (1 ml of drug solution each)
2: Placebo Comparator 4ml NaCl 0.9%	Drug: Placebo 4ml NaCl 0.9%

Detailed Description:

The treatment of the male CP/CPPS is often as unsuccessful as frustrating for patients and doctors. Because of that patients change their general practitioners or urologists quite regularly. One of the major problems is the unknown pathomechanism of the disease. Most patients are suffering from irritative voiding symptoms and a dysfunction of the pelvic floor. By looking at the various (non-) conservative therapeutical strategies it becomes quite clear that there is no unique and convincing therapeutical strategy.

At present Botulinum-Toxin Type A (BTX A) is widely used in the urological field especially for para-/tetraplegics patients having trouble with neurogenic bladder dysfunction. It has been reported in case series (doses: 200U and 30U) that BTX A injected into the external urethral sphincter is able to reduce the symptoms without provoking incontinence. This is implied with the hypothesis that obstructive voiding symptoms because of a CP/CPPS are associated with an incomplete relaxation of the bladder neck and the external urethral sphincter.

After having given their informed consent, patients undergo a screening visit and baseline evaluation including patients history, clinical examination, NIH-CPSI and IPSS-questionnaires, micturition diary, sonography, 4-glass test and urodynamics. Patients fulfilling the study eligibility criteria are randomized to receive intrasphincteric injection of either BTX A or placebo. There will be 5 follow-up visits including a post-treatment follow-up after 1 year.

Eligibility

Ages Eligible for Study:	18 Years to 70 Years
Genders Eligible for Study:	Male
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

CPPS NIH III (symptoms over 3 months during the last 6 months, 4 glass-test)
Pain Score ≥ 4

Exclusion Criteria:

During the last month: intake of antibiotics, alpha receptor blockers, anticholinergics; intake of analgesics containing opioids (longer than 4 days); participating in a different clinical trial
During the last 3 months:documented urinary infection, epididymitis, positive urinary culture; status post biopsy of the prostate gland; STD: Gonorrhea, Chlamydia, Mycoplasm, Trichomonads
During the last 6 months: Finasteride or any other 5α-reductase inhibitor
During the last 12 months: status post any surgery on the prostate gland; genital herpes; not adjustable hypertension, angina pectoris, heart failure (NYHA III-IV), Status post myocardial infarction, coronary bypass surgery or coronary dilatation
During the last 24 months: cerebral insult, TIA; active disease of the liver
Other urological diseases like prostate cancer, bladder cancer, status post radiation of the small pelvis, chemotherapy (intravesical or systemic)
Urinary catheter
Residual urine > 200ml
Serum creatinine > 200µmol/l
Status post injection of BTX A, hypersensitivity concerning any substances of content of BTX, myasthenia gravis
Any kind of cancer
Active inflammation (except the prostate gland)
Neurological or psychological disease making signing of a consent form or behaving according to a study protocol impossible
Abuse of drugs or alcohol during last 5 years
Any disease that may influence the results according to the opinion of the medical doctor

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00464373

Contacts

Contact: Daniel S Engeler, MD

+41714941430

daniel.engeler@kssg.ch

Locations

Switzerland
Department of Urology, Cantonal Hospital of St. Gallen	Recruiting
St. Gallen, Switzerland, 9007
Contact: Daniel S Engeler, MD +41714941430 daniel.engeler@kssg.ch
Principal Investigator: Daniel S Engeler, MD
Sub-Investigator: Christian Hobi, MD
Sub-Investigator: Daniel Meyer, MD
Sub-Investigator: Jürg Müller, MD
Sub-Investigator: Sacha Schmid, MD

Sponsors and Collaborators

Cantonal Hospital of St. Gallen

Allergan

Investigators

Principal Investigator:	Daniel S Engeler, MD	Department of Urology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
Study Director:	Hans-Peter Schmid, MD	Department of Urology, Cantonal Hospital of St. Gallen

More Information

No publications provided

Responsible Party:	Cantonal Hospital of St. Gallen ( Daniel S Engeler, MD )
Study ID Numbers:	BTX-URO-01, EKSG 06/056
Study First Received:	April 20, 2007
Last Updated:	February 3, 2009
ClinicalTrials.gov Identifier:	NCT00464373 History of Changes
Health Authority:	Switzerland: Swissmedic

Keywords provided by Cantonal Hospital of St. Gallen:

Prostatitis
Chronic Prostatitis with Chronic Pelvic Pain Syndrome
Botulinum Toxin Type A
Drug therapy
Injections, intramuscular

Additional relevant MeSH terms:

Disease Attributes
Disease
Prostatic Diseases
Anti-Dyskinesia Agents
Physiological Effects of Drugs
Neuromuscular Agents
Pain
Genital Diseases, Male
Pharmacologic Actions
Prostatitis
Signs and Symptoms

Botulinum Toxins
Pelvic Pain
Pathologic Processes
Mental Disorders
Therapeutic Uses
Syndrome
Chronic Disease
Peripheral Nervous System Agents
Botulinum Toxin Type A
Somatoform Disorders
Central Nervous System Agents

ClinicalTrials.gov processed this record on February 08, 2010