madman
Super Moderator
Introduction: Botulinum neurotoxin (BoNT) is a recognized therapeutic agent of modern medical care, routinely used to treat medical conditions affecting a variety of organ systems including the musculoskeletal, integumentary, and urological domains. Ongoing research is exploring BoNT's potential role as a therapeutic agent for a variety of male sexual pathologies.
Objective: To review and analyze the literature regarding BoNT as a treatment option for male sexual dysfunction.
Methods: A PubMed search was performed for English-language articles in peer-reviewed journals between 1970 and 2019 (with one article from 1897). Relevant articles referenced within these texts were also included. One article did not have an accompanied English full-text available. The following search terms were used: “Botox”, “Botulinum toxin”, “Botulinum toxin A”, “Onabotulinum A”, “Abobutlinum A”, “BoNT”, “BoNTA”, “Male sexual health”, “Male sexual pathology”, “Peyronie's disease”, “Premature ejaculation”, “Scrotal Pain”, “Penile Retraction”, “Scrotox”, “Erectile Dysfunction”, and “Botox in Urology”.
Results: There is interest in the potential role of BoNT in the treatment of male sexual pathologies. We identified studies that used BoNT to treat chronic scrotal content pain, premature ejaculation, erectile dysfunction, Peyronie's disease, penile retraction, and more. However, despite preclinical/clinical data indicating some potential efficacy and safety in these settings, a lack of robust clinical trial data has resulted in no current Food and Drug Administration-approved indications for the use of BoNT in the treatment of male sexual pathology. As a result, much of the current use of BoNT by today's providers are “off-label,” and ongoing clinical trials aim to further elucidate the potential role of this therapeutic agent.
Conclusion: Current data suggest that BoNT could have a potential role as a treatment option for certain types of male sexual pathologies. However, more randomized controlled trial data regarding its long-term safety and efficacy are necessary before widespread clinical adoption can take place.
RESULTS
* Chronic Scrotal Content Pain
* Premature Ejaculation
* Erectile Dysfunction
* Peyronie's Disease
* Penile Retraction
* Scrotal Aesthetics
CONCLUSION
The utilization of BoNT-A in the treatment of male sexual dysfunction represents a relatively new domain of urological research. Based on the current literature available, it is evident that a great deal of RCT data and a much more robust understanding of the potential underlying pathways involved in mediating the effects of BoNT-A are necessary before any further clinical adoption. The current data show mixed outcomes for the treatment of various sexual pathologies but pave the way for future investigation into topics such as more optimal dosing regimens that could improve treatment efficacy, potential roles for other BoNT serotypes in the treatment of male sexual pathology, and the use of combination therapies involving BoNTA. It should be noted that even if future studies yield more promising results, the realistic clinical utility of BoNT-A for the treatment of any specific male sexual pathology will likely ultimately be predicated on the existing treatment landscape. In the case of pathologies such as ED and PD, which already have a variety of proven therapies, there will be a much higher barrier to any clinical adoption than for conditions such as CSP and penile retraction, where the existing therapies are ineffective and limited options currently exist. With respect to safety, while many of the studies noted in this review described minimal adverse effects or complications resulting from BoNT-A administration, these were all in the context of immediate or short-term follow-up. Longterm safety data, especially in patients with repeated administration, are necessary; however, they will likely not be available for the foreseeable future, and this should be communicated to patients before any BoNT-A therapy. Overall, BoNT-A is intriguing and often used therapy in modern clinical medicine. However, its role in the treatment of male sexual pathology remains highly variable at this time and will likely depend on the findings of future studies.
Objective: To review and analyze the literature regarding BoNT as a treatment option for male sexual dysfunction.
Methods: A PubMed search was performed for English-language articles in peer-reviewed journals between 1970 and 2019 (with one article from 1897). Relevant articles referenced within these texts were also included. One article did not have an accompanied English full-text available. The following search terms were used: “Botox”, “Botulinum toxin”, “Botulinum toxin A”, “Onabotulinum A”, “Abobutlinum A”, “BoNT”, “BoNTA”, “Male sexual health”, “Male sexual pathology”, “Peyronie's disease”, “Premature ejaculation”, “Scrotal Pain”, “Penile Retraction”, “Scrotox”, “Erectile Dysfunction”, and “Botox in Urology”.
Results: There is interest in the potential role of BoNT in the treatment of male sexual pathologies. We identified studies that used BoNT to treat chronic scrotal content pain, premature ejaculation, erectile dysfunction, Peyronie's disease, penile retraction, and more. However, despite preclinical/clinical data indicating some potential efficacy and safety in these settings, a lack of robust clinical trial data has resulted in no current Food and Drug Administration-approved indications for the use of BoNT in the treatment of male sexual pathology. As a result, much of the current use of BoNT by today's providers are “off-label,” and ongoing clinical trials aim to further elucidate the potential role of this therapeutic agent.
Conclusion: Current data suggest that BoNT could have a potential role as a treatment option for certain types of male sexual pathologies. However, more randomized controlled trial data regarding its long-term safety and efficacy are necessary before widespread clinical adoption can take place.
RESULTS
* Chronic Scrotal Content Pain
* Premature Ejaculation
* Erectile Dysfunction
* Peyronie's Disease
* Penile Retraction
* Scrotal Aesthetics
CONCLUSION
The utilization of BoNT-A in the treatment of male sexual dysfunction represents a relatively new domain of urological research. Based on the current literature available, it is evident that a great deal of RCT data and a much more robust understanding of the potential underlying pathways involved in mediating the effects of BoNT-A are necessary before any further clinical adoption. The current data show mixed outcomes for the treatment of various sexual pathologies but pave the way for future investigation into topics such as more optimal dosing regimens that could improve treatment efficacy, potential roles for other BoNT serotypes in the treatment of male sexual pathology, and the use of combination therapies involving BoNTA. It should be noted that even if future studies yield more promising results, the realistic clinical utility of BoNT-A for the treatment of any specific male sexual pathology will likely ultimately be predicated on the existing treatment landscape. In the case of pathologies such as ED and PD, which already have a variety of proven therapies, there will be a much higher barrier to any clinical adoption than for conditions such as CSP and penile retraction, where the existing therapies are ineffective and limited options currently exist. With respect to safety, while many of the studies noted in this review described minimal adverse effects or complications resulting from BoNT-A administration, these were all in the context of immediate or short-term follow-up. Longterm safety data, especially in patients with repeated administration, are necessary; however, they will likely not be available for the foreseeable future, and this should be communicated to patients before any BoNT-A therapy. Overall, BoNT-A is intriguing and often used therapy in modern clinical medicine. However, its role in the treatment of male sexual pathology remains highly variable at this time and will likely depend on the findings of future studies.
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