{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:25:23Z","timestamp":1791440723257,"version":"4.3.3"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T00:00:00Z","timestamp":1746489600000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Patients with erectile dysfunction (ED) are often left with limited nonsurgical options when conventional pharmacotherapies become ineffective. Botulinum neurotoxin serotype A (BoNT-A) intracavernosal injections (ICIs) have been demonstrated in a few clinical studies to be effective and safe in managing ED and may serve as a first- or second-line option.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>To perform a systematic review and meta-analysis on the effectiveness and safety of BoNT-A ICI in managing ED with a focus on human studies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A systematic review and meta-analysis of clinical studies was performed in accordance with the PRISMA 2020 statement. Adult men with ED who received BoNT-A were included in the study. The risk of bias assessment of included studies was performed using the JBI assessment checklists.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>The effectiveness and safety of BoNT-A ICI. Measures of effectiveness included the increase or change in International Index for Erectile Function (IIEF-EF) score\/Sexual Health Inventory for Men (SHIM) score\/Erection Hardness Score (EHS) or change in Doppler ultrasound parameters and the percentage of patients achieving the minimal clinically important difference (MCID) score.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The search retrieved 61 articles, and 2 randomized controlled trials (RCTs) and 4 retrospective studies met the inclusion criteria. Three types of BoNT-A were evaluated: onaBoNT-A, aboBoNT-A, and incoBoNT-A. At least 40% of the patients achieved the MCID (2-7 points increase in the IIEF-EF\/SHIM score) depending on the severity of ED) at \u22651\u00a0month. When directly comparing all 3 BoNT-A, the overall response rate was 77.5%, with no statistically difference between the 3 types. For aboBoNT-A, 500\u00a0U appeared to sustain the effectiveness longer compared to 250\u00a0U. OnaBoNT-A improved peak systolic velocity on Doppler ultrasound compared with saline. Meta-analysis of the 2 RCTs demonstrated a mean difference of 4.35 (P\u2009=\u2009.008) in the SHIM score at 12\u00a0weeks in favor of onaBoNT-A over normal saline. No systemic side effects have been reported, and the only infrequent local side effect was transient penile pain. Only one case of priapism was reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths and Limitations<\/jats:title>\n                  <jats:p>This is the first systematic review summarizing data from human studies on ED and BoNT-A ICI. The inclusion criteria and outcomes of the included studies varied, which limited the number of studies included and parameters assessed in the meta-analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>BoNT-A may become an acceptable non-surgical option. However, there is a lack of clinical randomized or observational studies on this topic, and more randomized studies with standardized reporting are required to replicate current results and investigate the long-term benefits of BoNT-A as a monotherapy or adjunct therapy in the management of ED.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/sexmed\/qfaf034","type":"journal-article","created":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T07:44:53Z","timestamp":1746517493000},"source":"Crossref","is-referenced-by-count":7,"title":["The effectiveness and safety of intracavernosal botulinum toxin injections in the management of erectile dysfunction: a systematic review and meta-analysis of clinical studies"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5703-2319","authenticated-orcid":false,"given":"Karl H","family":"Pang","sequence":"first","affiliation":[{"name":"Division of Surgery and Interventional Science, University College London 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