Editorial Comment: Intra-cavernous injection of BOTOX ® (50 and 100 Units) for treatment of vasculogenic erectile dysfunction: Randomized controlled trial

Abstract

Onabotulinum toxin-A (BTX) is widely used to treat various medical conditions such as striated and smooth muscle disorders. In urologic disorders, the use of BTX has been approved to treat detrusor overactivity (1).Despite the various therapeutic options for the treatment of erectile dysfunction (ED), there is a need for a new effective and safe treatment for patients who are refractory to noninvasive therapies. Some studies have suggested the possible role of intracavernosal injection (ICI) of BTX for the treatment of ED, which has aroused interest in the area of sexual medicine (2-4).BTX inhibits sympathetic adrenergic or cholinergic vasoconstriction, sensory nerves, decreasing the tone of penile resistance vessels, blood flow, and cavernosal smooth muscle tone, which are involved in the pathophysiology of DE (5).In this interesting study, the authors compared the safety, efficacy and durability of ICI of BTX at different doses (50 and 100µ) against placebo (saline) in the management of vasculogenic ED non-responsive to pharmacological therapy (phosphodiesterase type 5 inhibitors and/or ICI of trimix). They conducted a prospective randomized double-blind placebo-controlled trial involving 176 patients, who were randomly assigned to one of the treatments. All patients were monitored for six months. Significant improvements in all parameters (Sexual Health Inventory for Men Score, Erection Hardness Score, Sexual Encounter Profile, Global Assessment Score, and Doppler parameters) were observed in patients in the BTX-100µ and BTX-50u groups, with maximum improvement in the third month of treatment. BTX-100U was more dura-