title: Botulinum toxin a (Botox) for relieving penile retraction.
abstract: BACKGROUND
  The flaccid penis undergoes retraction upon contraction of the dartos muscle. These contractions are most pronounced in the situations of cold, stress, and upon exercising, and can be the source of embarrassment to those who have a hyperactive retraction reflex, especially when exposed to their partners or to others in showers and dressing rooms, despite a normal and satisfactory length in the erect state.
  
  
  OBJECTIVE
  In this work, we propose an alternative to surgery and penile extenders for alleviating penile retraction, by injection of botulinum toxin into the dartos to induce muscle relaxation. This is the first report of the technique.
  
  
  METHODS
  Ten male patients complaining of a short penis exclusively in the flaccid state, despite normal and satisfactory erect and outstretched lengths, were selected for the study. One hundred units of BOTOX were injected into the dartos muscle.
  
  
  METHODS
  Frequency and amplitude of penile retraction, flaccid unstretched length, and patient satisfaction.
  
  
  RESULTS
  Seven out of 10 cases (70%) subjectively reported a decrease in the frequency and amplitude of penile retraction, as well as improvement in flaccid length. Clinical measurements were less pronounced but still showed an improvement that was mainly in terms of less retraction rather than more length. No side effects were reported. Improvement faded completely by the 6th month.
  
  
  CONCLUSIONS
  This preliminary report of botulinum toxin A (Botox) injection into the dartos muscle shows that Botox may have a potential effect in temporarily decreasing penile retractions in terms of frequency and amplitude.
authors.affiliation: Department of Andrology, Cairo University, Egypt, 21 Gaber Ibn Hayan Street, Dokki, Cairo 12311 ARE, Egypt. dr.osama@alrijal.com
authors.forename: Osama
authors.initials: O
authors.lastname: Shaeer
authors.forename: Kamal
authors.initials: K
authors.lastname: Shaeer
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shaeer
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009119:Muscle Contraction / Q000187:drug effects; D009126:Muscle Relaxation / Q000187:drug effects; D009130:Muscle, Smooth / Q000187:drug effects*; D009465:Neuromuscular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017060:Patient Satisfaction; D010409:Penile Diseases / Q000188:drug therapy*; D010410:Penile Erection / Q000523:psychology; D010413:Penis / Q000187:drug effects*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A