The following is the summary of “Intra-Cavernosal Injection of Botulinum Toxin in the Treatment of Erectile Dysfunction: a Systematic Review and Meta-Analysis” published in the December 2022 issue of Urology by Zahr, et al.

The purpose of this study is to assess the efficacy of botulinum toxin as a novel therapeutic option for erectile dysfunction that can help men avoid invasive and, perhaps, fatal operations. Starting in January 1990 and ending on July 31, 2021, a comprehensive literature search was performed. Researchers searched PubMed, Embase, and Medline to find English-language studies on botulinum toxin and erectile dysfunction. Investigators considered a total of 7 trials in their analysis, 2 of which were pre-clinical. 

About 3 outcomes shared by at least 2 trials were pooled together for this meta-analysis. The Erection Hardness Score (EHS), Peak Systolic Velocity (PSV) in the cavernosal artery, and the Sexual Health Inventory for Men (SHIM) score were among the variables examined. An MD of 10.82 [4.99, 16.65] and a heterogeneity of (I2=61%) indicate that intracavernosal injection (ICI) of botulinum toxin (BoNT-A) is beneficial to PSV. With an MD of 0.7 [0.47, 0.93] and heterogeneity of (I2=94%), the EHS results favored BoNT-A as well over placebo. There was also no statistically significant difference in SHIM scores (I2=85%) (MD 0.58 [-0.03, 1.20]).

When looking at EHS and PSV, our review and meta-analysis demonstrate that BoNT-A is statistically superior. This statistical significance must be evaluated with caution due to the following caveats: small sample size, heterogeneity in data collection, patient selection bias, and clinical importance of the detected differences. Right now, only clinical trials of BoNT-A ICI should be done to further understand its clinical utility.