**9. Conclusions**

Based on the current basic and clinical studies, BoNT-A could still be effective in certain subsets of BPH with LUTS, especially in males with concomitant CP/CPPS and smaller prostate. However, this hypothesis requires further validation through randomized controlled clinical studies. In addition, it is imperative to consider exploring biomarkers of BPH, including NGF level, mast cells/distribution of activated subtypes of immune cells in biopsies, inflammatory-associated cytokines, or ANS dysfunction, as determining predictors of the treatment efficacy. Therefore, for effectiveness, the treatment of BPH with BoNT-A should be tailored according to more detailed clinical information and reliable biomarkers.

**Author Contributions:** Conceptualization, B.-J.C. and H.-C.K.; methodology, B.-J.C., H.-C.K. and C.-H.L.; writing—original draft preparation, B.-J.C.; writing—review and editing, B.-J.C., H.-C.K. and C.-H.L.; supervision, H.-C.K. and C.-H.L.; project administration, H.-C.K.

**Funding:** This work was supported by the Ministry of Science and Technology (106-2314-B-567-002-, and 107-2314-B-567-002-MY2-2), and Cardinal Tien Hospital (CTH106A-2A14 and CTH107A-2A19).

**Conflicts of Interest:** The authors declare no conflict of interest.
