Objectives: Based on clinical experience and representative, clinical photography, an injection technique for penile girth enlargement is proposed, including limits and side effects.

Introduction: The desire to have a larger penis is not uncommon. Given the important psychological impact of such treatment but also of potential complications, it is important to select the best candidates for a treatment which is kept as minimally invasive as possible and reversible.

Materials / method: To prepare for subcutaneous injection of hyaluronic acid gel in the penis, a ring anaesthesia is performed at the base with 10 ml of lidocaine. For intradermal injections of the glans penis, topical application of Lidocaine 23 % Tetracaine-HCl 3,5% Tetracaine-Base 3,5% ointment under occlusive dressing is sufficient.

Results: Premature ejaculation and misconceptions about the physical impact of injections on a partners pleasure are the most frequently requested poor indications for this procedure. Less than half the patients consulting for the procedure are good candidates. The injection of 6 to 10 ml with a short-term top-up of 2-4 ml gives a pleasing result in most candidates. The corona of the glans can be injected with 1 or 2 ml of gel. Temporary, soft irregularities are common but resolve over time. Circumcision is a risk factor for unsightly swelling of skin tags.

Conclusion: Patients who want the psychological benefit of penile girth enlargement (when the penis is in a flaccid state) can benefit from subcutaneous, (or in the glans intradermal) injection of hyaluronic acid gel. Lengthening of the penis after this treatment is not uncommon. It seems that subcutaneous injection of gel impedes physiological retraction of the penis as a response to stress, anger or cold. This may improve self-esteem in patients with a retractile penis. It is unlikely that the enlargement can be felt by a partner during intercourse.

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Objectives: Explaining the vascular mechanisms in penile erection.
Explaining the treatment lines for Erectile Dysfunction.
Explaining the potential role of Botulinum Toxin in the treatment of Erectile Dysfunction.
Review the literature, and present studies published to date, evaluating the possible role of Botulinum Toxin in the treatment of Erectile Dys

Introduction: There are 3 components in the vascular erectile response to sexual stimulation. Arterial dilatation to deliver blood to the cavernosal tissue, sinusoidal smooth muscle relaxation to accommodate the incoming blood, passive venous occlusion due to the compression veins by the expanding sinusoids to build up pressure. Botulinum toxin has been postulated to improve erections through facilitating sinusoidal smooth muscle relaxation.

Materials / method: We present our work and that of others that addressed the topic. We also conducted a literature search with search terms including Erectile Dysfunction and Botulinum Toxin.

Results: Human and animal studies, have been conducted in Egypt, France and Canada, by 4 different groups of investigators, suggesting a possible role for Botulinum Toxin Type A (BoNT-A) as a treatment for Erectile Dysfunction (ED).
Two animal studies and 4 human studies all suggested a positive effect of botulinum toxin, injected Intra-cavernously, in improving Erectile Dysfunction. It was not clear in randomized controlled trials which subgroup of Erectile Dysfunction patients improved most compared to placebo.

Conclusion: Current evidence suggests that Botulinum toxin, injected Intra-cavernously, improves erectile function, compared to placebo. Further studies are needed to confirm these results and identify subsets of patients who would benefit most from this line of treatment.

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