(501) Intracavernosal Botulinum Toxin Type A for Erectile Dysfunction: A Retrospective Audit Combining Patient-Reported and Wearable-Derived Outcomes

Introduction Erectile dysfunction (ED) is a multifactorial condition with limited options for patients who respond suboptimally to phosphodiesterase type 5 inhibitors (PDE5i). Botulinum toxin type A (BoNT-A) has emerged as a novel therapy for enhancing erectile function by neuromodulatory inhibition of sympathetic hyperactivity, facilitating cavernosal smooth muscle relaxation and improving penile hemodynamics. Objective To evaluate the therapeutic outcomes of intracavernosal BoNT-A injection in men with vasculogenic ED using both validated questionnaires and objective nocturnal erection data obtained through a wearable device. Methods Men with secondary, vasculogenic, and progressively worsening ED were included. All were physically healthy, in stable relationships, and had not previously received treatment for ED. None had commenced phosphodiesterase-5 (PDE-5) inhibitors or other therapies. Each patient received a single intracavernosal injection of 100 units of onabotulinum toxin A (Allergan) diluted in 2.5 mL normal saline. Outcomes were assessed using the International Index of Erectile Function (IIEF-5), a validated sexual performance anxiety questionnaire, and nocturnal erection data collected via a commercially available wearable device (smart FDA approved penile ring). Changes in erection frequency, duration, and tumescence were analysed over an eight-week period. Results All participants reported subjective improvement in erectile function and reduction in performance anxiety. Mean IIEF-5 scores increased at 8 weeks (p < 0.05). Objective wearable data demonstrated an increase in nocturnal penile tumescence, with patients achieving improvement relative to baseline (p < 0.05), alongside enhanced rigidity metrics (p < 0.05). No local or systemic adverse events were observed. Conclusions Intracavernosal BoNT-A injections significantly improved erectile function and reduced performance anxiety in men with vasculogenic ED who were naïve to prior treatment. Objective data from a commercially available wearable device corroborated subjective findings, demonstrating increased nocturnal erection frequency and rigidity. These results support the potential therapeutic value and high safety profile of BoNT-A as an adjunctive approach for ED management. Furthermore, integrating wearable technology into andrology practice enhances the objectivity of treatment evaluation, transforming subjective clinical impressions into measurable outcomes and improving both scientific validity and patient engagement. Disclosure No