Discover the surprising potential of Botox in treating Erectile Dysfunction, a widespread issue among men. Tune in as Dr. Rena ...

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Is Botox The New Viagra? Urologist Explains Botox for Stronger Erections &amp; a Longer Penis?!

have you heard of Botox for erectile dysfunction I'm Dr Reena Malik urologist and pelvic surgeon and today I'm going to teach you about the new data on how Botox might be useful for erectile dysfunction now Botox is everywhere people are using it for wrinkles people are using it for muscular spasms people are using it for overactive bladder but now people are using it for erectile dysfunction so how does that exactly work well when we learn about erectile function we learn little pneumonic called point and shoot and that means that point meaning getting an erection is due to the parasympathetic nervous system and Botox works by inhibiting the sympathetic nervous system or preventing the release of nor epinephrine and that then causes relaxation of the blood vessels as well as the smooth muscle in the penis and if you remember from some of my prior videos an erection occurs when smooth muscle relaxes allowing blood to flow into the penis causing those corpor cavernosa or those spongy erectile tissues to get firm and full of blood interestingly the sympathetic nerve system when it's in overdrive has been associated with a number of conditions including high blood pressure diabetes es schic heart disease and many others it's also thought to be a part of vascular erectile dysfunction now erectile dysfunction has multiple different causes but the most common cause is gas glooming there's a decrease in blood flow to the penis or an increase in blood flow leaving the penis before it's ready now interestingly there is some data on BOTOX for erectile dysfunction that is pretty interesting and it is a small amount of data but actually quite compelling now the first couple of studies that were done in this area were randomized control trials meaning that they had patients who received Botox injections and those who received an injection of saline into the corpos now they used different formulations of botulinum tox toxin there are actually different formulations like onabotulinum toxin so they used different formulations at different doses one of the initial most powerful studies was a randomized control trial looking at 24 patients of which half received Botox injections to the erectile tissue of the penis and the other half received saline and in this small group they did see a significant Improvement particularly for men who had failed treatment with pills for erectile dysfunction or pde5 Inhibitors like Selen tadalfil or venil you can learn more about those medications in my videos on cenil and tadalfil but they had failed those as well as intracaval injections for erectile dysfunction and so in this early studies they followed people for 4 weeks and they saw that they did have significant improvements in hardness and erectile function the next randomized control trial looked at different doses of onabot toxin they looked to either 50 units or 100 units and they again use the same cord of men who were not responsive to pde5 inhib Inhibitors or inter cavernosal injections and so in this group they had 176 patients and they followed these patients up to 6 months and they did different doses like I said 50 units or 100 units and what they found was that 50 units and 100 units did show significant Improvement both up to 3 months but at 6 months the 100 unit dose continued to show Improvement whereas the 50 unit dose started to decrease so interestingly for those of you who use btox for other reasons you may find that it only lasts for about 3 months months but in bladder conditions when we use it for overactive bladder or neurogenic bladder it can last 6 to 12 months and we've seen it lasts in patients on average of about 9 months so in this case it appears that higher doses tend to last a little bit longer now remember Botox does wear off so if you do receive an injection for erectile dysfunction you might notice that over time the efficacy will wear off and you will need repeated injections now I want to preface this before I go on to say this is not an FD approved treatment it is not in guidelines currently this is just very early data showing its efficacy the large majority of this has been done outside of the United States in France or in Europe we still don't have enough data that it's been incorporated into guidelines for the treatment of erectile dysfunction so the next big study was a randomized placebo controlled trial that was blinded which mean that they took a group of 176 patients a third of them received 50 units of Botox a third of them received 100 units of Botox a third of them received saline but the person administering the injection didn't know what they were giving and they wanted to see if patients improved with erectile function and the way they do this as they do in many studies for erectile dysfunction is by assessing a validated questionnaire which tells us do you have mild moderate or severe erectile dysfunction and they want to see a Improvement of Four Points in this questionnaire which is considered a clinically meaningful Improvement meaning that you as a patient would see this as an improvement what they saw in this was that the 50 unit and the 100 unit group did improve at 3 months by about 5 or six points but at 6 months the 50 unit group started to drop off so their scores went back to Baseline but the 100 unit group remained improved up to 6 months interestingly they also saw improvements in Penal systolic velocity so what does that mean that's an ultrasound measurement of blood flow to the penis so they saw significant improvements in that and interestingly they also saw an increase in stretched penal length now if you're new here stretched penal length is a surrogate of erectile length because you typically are not getting erection in the doctor's office unless you're getting some medication or you're purposely trying to get one we make it more comfortable by measuring stretch penal length so they did see an increase of about 1 cm in stretch penal length but after the botox wore off particularly in that 50 unit group we saw a decrease back towards the Baseline in stretch Penal and really what matters is how many people were able to then resume having sexual activity meaning their erections were firm enough for penetration well about 40% so while this is not a huge home run this is a subset of patients who have very severe erectile dysfunction they are not responding to medications they are not responding to injections and they might be well on their way to having surgery like a penal implant so if you want to learn more about penal implants check my video on that now other St have tried to look at how this works over a long period of time so the next study I want to talk about is a real world study they took 216 men who were getting BOTOX for erectile dysfunction and they wanted to see how many people had Improvement and how many people went on to get a second injection and what the Improvement was in the group that got a second injection of those 216 men 92 or almost 43% went on to get a second injection so they requested a second injection and the time between the first injection and the second was about on average 9 months now the last thing I want to share with you looked at again early and late assessment of these patients so well after 6 months and early as in the first month or so and the other thing they looked at was the response between different severities of erectile dysfunction so did they have mild moderate or severe Ed to begin with and how many of those went on to improve in the say they again looked at this same survey the international index of erectile function or sexual health inventory for men which says okay this is the number of points you need to improve to see a clinically important difference now it's different for patients with mild Ed to moderate Ed and severe Ed you clearly need a larger change in your erectile function to see a meaningful difference in patients who have severe Ed versus those who have mild so they use different cut offs in this study and they included 123 men who were on average 53 years of age and had Ed anywhere from 2 to 10 years with a median of 5 years and the response rate in patients with mild Ed was really really high it was 90% those with moderate Ed had a response of about 55% and those with severe Ed had about a response of 33% and that response actually improved if they were also taking medication or also getting intracavernosal injection therapy so if they were taking either of those their response went from 33% to upwards 50 to 60% % they also looked at different categories of men with different types of erectile dysfunction so men who had a prostectomy or spinal cord injury were less likely to see a response now the late response group was anywhere from 3 months to 8 months after their first injection with a mediate of about 5 months of those who had an early response about 76% of them continued to have a response at that time point so we do see then a subset of patients who are continuing to respond well into somewhere between 3 to 8 months the good news is there's very little risk with this procedure the only kind of reported side effect in multiple studies was pain and most of the time that pain went away after the injection pain persisting after the injection was exceedingly rare less than 1% of people now as I mentioned earlier this is still early data this is again not recognized by the major societies that look at sexual function like the sexual medicine Society of North America the American neurological Association this is still very early in study and not something that is widely available and certainly not covered by Insurance it is however kind of exciting to see an additional option for patients that may allow them to see benefit with medication before they need something like surgery did you know I started a podcast well my podcast is called the arena Malik MD podcast where I'll be releasing content every week that is either myself talking or talking with experts about sexual function about your health about all sorts of things that you are interested in so please do me a favor subscribe check it out on Spotify apple or your favorite podcast platform and leave a rating or review it is super helpful for me to get people to learn and hear more about your logic education and sexual health so everyone can get healthier and happier if you're not a podcast listener don't worry I will be releasing those podcasts as videos for your viewing pleasure as well please comment below let me know what you thought of this video as well as any guests you'd want to see me interview on my podcast and as always want to take care of yourself because you're worth it

Dr.

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