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Testosterone Replacement, Low T, HCG, & Beyond
When Testosterone Is Not Enough
Botox for Erectile Dysfunction
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<blockquote data-quote="madman" data-source="post: 264952" data-attributes="member: 13851"><p><strong>EAU Guidelines on Sexual and Reproductive Health 2023</strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>5.6 Treatment of erectile dysfunction</strong></p><p><strong></strong></p><p><strong>5.6.2.8 Other treatments </strong></p><p><strong></strong></p><p><strong><em>5.6.2.8.1 Botulinum Neurotoxin</em></strong></p><p></p><p><em>Botulinum Neurotoxin A (BoNT-A) is the most commonly used toxin serotype in everyday clinical practice work-up for the management of musculoskeletal, integumentary and urological disorders.<strong> Over thst decade BoNT-A has also been investigated also as a possible treatment of ED [595]. On the one hand, this effect is due to the <u>relaxation of the cavernosal smooth muscle secondary to the inhibition of noradrenaline release by the adrenergic neurons which reduces the overall sympathetic tone and facilitates the occurrence of erection after stimulation</u> [596]. On the other, BoNT-A is able to <u>block also the release of acetylcholine from parasympathetic neurons which is crucial for the subendothelial increase of nitric oxide responsible for the erection</u>; as such, it has been proposed that the dilatation of sinusoids at the level of the corpora will be sustained only by the nitric oxide released after stimulation by the non-adrenergic non-cholinergic neurons [596]. <u>Two double-blind placebo-controlled RCTs have investigated the effect of BoNT-A for the treatment of patients with ED who were non-responders to PDE5is or ICI of pro-erectile drugs</u> [597, 598].</strong> One RCT randomized 70 patients with ED refractory to PDE5Is to receive a single ICI of 100 UI of BoNT-A or saline [597]. Patients in both groups were instructed to keep using on-demand high-dose PDE5Is. <strong>The RCT showed an improvement in EHS and PSV at two weeks post-treatment. At six weeks the treatment group showed a 5 points improvement in the SHIM score vs. no improvement in the placebo group, with 53% of patients reporting an erection hard enough for vaginal penetration [597]. </strong>The second RCT randomized 176 patients, all non-responders to PDE5Is or ICI trimix, to three treatment groups: BoNT-A 100 UI; BoNT-A 50 UI; or placebo [598]. A significant improvement in SHIM, EHS and SEP scores was reported in both treatment groups with a maximum response rate being reacted three months after treatment. <strong>Overall, the RCT showed that up to 40% of patients were able to resume satisfactory sexual activity after treatment [598]. Both trials reported only mild local side-effects with no systemic complications. </strong></em></p><p><em><strong></strong></em></p><p><em><strong>Other single-arm, non-controlled studies have confirmed these findings [599, 600]; therefore, <u>showing a promising role for BoNT-A in the treatment of patients who are non-responders to well-established ED therapies</u>.</strong> <strong>At present, the Guidelines panel considers that <u>no recommendations can be provided, since larger trials are needed to confirm these findings and define the efficacy and safety of BoNT-A for ED</u>.</strong></em></p></blockquote><p></p>
[QUOTE="madman, post: 264952, member: 13851"] [B]EAU Guidelines on Sexual and Reproductive Health 2023 5.6 Treatment of erectile dysfunction 5.6.2.8 Other treatments [I]5.6.2.8.1 Botulinum Neurotoxin[/I][/B] [I]Botulinum Neurotoxin A (BoNT-A) is the most commonly used toxin serotype in everyday clinical practice work-up for the management of musculoskeletal, integumentary and urological disorders.[B] Over thst decade BoNT-A has also been investigated also as a possible treatment of ED [595]. On the one hand, this effect is due to the [U]relaxation of the cavernosal smooth muscle secondary to the inhibition of noradrenaline release by the adrenergic neurons which reduces the overall sympathetic tone and facilitates the occurrence of erection after stimulation[/U] [596]. On the other, BoNT-A is able to [U]block also the release of acetylcholine from parasympathetic neurons which is crucial for the subendothelial increase of nitric oxide responsible for the erection[/U]; as such, it has been proposed that the dilatation of sinusoids at the level of the corpora will be sustained only by the nitric oxide released after stimulation by the non-adrenergic non-cholinergic neurons [596]. [U]Two double-blind placebo-controlled RCTs have investigated the effect of BoNT-A for the treatment of patients with ED who were non-responders to PDE5is or ICI of pro-erectile drugs[/U] [597, 598].[/B] One RCT randomized 70 patients with ED refractory to PDE5Is to receive a single ICI of 100 UI of BoNT-A or saline [597]. Patients in both groups were instructed to keep using on-demand high-dose PDE5Is. [B]The RCT showed an improvement in EHS and PSV at two weeks post-treatment. At six weeks the treatment group showed a 5 points improvement in the SHIM score vs. no improvement in the placebo group, with 53% of patients reporting an erection hard enough for vaginal penetration [597]. [/B]The second RCT randomized 176 patients, all non-responders to PDE5Is or ICI trimix, to three treatment groups: BoNT-A 100 UI; BoNT-A 50 UI; or placebo [598]. A significant improvement in SHIM, EHS and SEP scores was reported in both treatment groups with a maximum response rate being reacted three months after treatment. [B]Overall, the RCT showed that up to 40% of patients were able to resume satisfactory sexual activity after treatment [598]. Both trials reported only mild local side-effects with no systemic complications. Other single-arm, non-controlled studies have confirmed these findings [599, 600]; therefore, [U]showing a promising role for BoNT-A in the treatment of patients who are non-responders to well-established ED therapies[/U].[/B] [B]At present, the Guidelines panel considers that [U]no recommendations can be provided, since larger trials are needed to confirm these findings and define the efficacy and safety of BoNT-A for ED[/U].[/B][/I] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
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