Peyronie's disease (PD) presents a multifaceted challenge in contemporary urological practice, marked by penile deformity, pain, and the potential for erectile dysfunction. We meticulously explored the existing literature of intralesional/topical interventions, aiming to provide clinicians with a nuanced understanding of available options for comprehensive PD management. To conduct this review, we performed a systematic search using the PubMed, Scopus, and ScienceDirect databases, including the keywords of combination of the "Peyronie's disease/plastic induration of the penis (PIP) and intralesional/topical treatments". The study selection was based on adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, resulting in the inclusion of 16 articles. We delve into the effectiveness and safety profiles of collagenase Clostridium histolyticum (CCH), interferon, platelet-rich plasma (PRP), hyaluronic acid, botulinum toxin, stem cell, extracorporeal shock wave therapy (ESWT), and traction therapy, assessing their impact on penile curvature, length improvement, and patient-reported symptoms and outcomes. The best options evaluated are intralesional injections of CCH and penile traction devices, alone or in combination. Despite PD remains a challenge for urologists, the objective of this review is to contribute to the evolving landscape of PD management, fostering informed decision-making, and personalized care for individuals grappling with this challenging condition.
Humans ; Male ; Administration, Topical ; Botulinum Toxins/administration & dosage* ; Extracorporeal Shockwave Therapy ; Hyaluronic Acid/administration & dosage* ; Injections, Intralesional ; Interferons/administration & dosage* ; Microbial Collagenase/administration & dosage* ; Penile Induration/therapy* ; Platelet-Rich Plasma ; Stem Cell Transplantation ; Traction

Objective:This study aims to explore the clinical effectiveness of a novel treatment method for refractory laryngeal contact granuloma, involving CO2 laser excision with local pedicled mucosal flap transfer combined with type A botulinum toxin injection. Methods:A retrospective analysis was conducted on 18 patients with refractory laryngeal contact granuloma who visited Department of Otolaryngology Head and Neck Surgery, Nanjing Tongren Hospital, School of Medicine, Southeast University from January 2021 to June 2023. These patients underwent CO2 laser excision of the granuloma with local pedicled mucosal flap transfer combined with type A botulinum toxin injection. During follow-up, electronic laryngoscopy were performed at 1, 3, 6, and 12 months postoperatively, and local laryngeal mucosa, voice quality, and pharyngeal discomfort symptoms were evaluated. Results:Postoperative electronic laryngoscopy revealed the disappearance of granulomas in all 18 patients. Symptoms such as hoarseness, foreign body sensation in the throat, and cough were significantly improved. No complications were observed systemically or locally. No recurrence was observed during one-year follow-up. Conclusion:CO2 laser excision of granuloma with local pedicled mucosal flap transfer combined with type A botulinum toxin injection could eliminate the lesion, restore the integrity of the vocal fold lining, preserve the perichondrium, and provide a time window for mucosal flap recovery. This approach adheres to the principle of preserving normal mucosa, achieves a high cure rate, and is therefore worthy of widespread promotion and application in clinical practice.
Humans ; Retrospective Studies ; Surgical Flaps ; Botulinum Toxins, Type A/administration & dosage* ; Male ; Female ; Granuloma/therapy* ; Adult ; Middle Aged ; Granuloma, Laryngeal/therapy* ; Laryngeal Diseases/therapy* ; Lasers, Gas/therapeutic use* ; Laryngoscopy ; Laser Therapy ; Treatment Outcome

Adult ; Botulinum Toxins ; administration & dosage ; pharmacology ; Humans ; Injections, Intramuscular ; Male ; Muscle Spasticity ; chemically induced ; diagnosis ; Neuromuscular Agents ; administration & dosage ; pharmacology ; Transcranial Magnetic Stimulation ; methods

Overactive bladder (OAB) is a symptom-driven condition characterized by urinary urgency with or without urinary incontinence and a common problem that can significantly affect quality of life. Drugs that prevent acetylcholine-mediated involuntary detrusor contractions are the mainstay of OAB treatment, but several alternative therapeutic options have become established treatments for OAB. Mirabegron (a β3-adrenoceptor agonist) has a different mechanism of action from antimuscarinic agents. Recently published randomized controlled trials have shown that mirabegron is an effective and safe drug for the symptomatic treatment of OAB patients. Mirabegron represents a valid option both for patients with OAB who are antimuscarinics treatment-naïve, as well as for those who are unresponsive or intolerant to antimuscarinics. Intravesical injection of botulinum toxin A is an effective treatment for OAB that is refractory to antimuscarinics. Treatment with botulinum toxin A showed clinically relevant improvement in all OAB symptoms and health-related quality of life. It was generally well tolerated by most patients, and most treatment-related complications were acceptable. However, increased risk of a larger volume of post-void residual urine was noted in several patients and the possibility of chronic catheterization requires careful evaluation before treatment. In sum, recent options for management of OAB, mirabegron and intravesical injection of botulinum toxin A, expand the treatment options for the optimal treatment of each patient.
Administration, Intravesical ; Botulinum Toxins* ; Catheterization ; Catheters ; Drug Therapy* ; Humans ; Muscarinic Antagonists ; Quality of Life ; Urinary Bladder, Overactive* ; Urinary Incontinence

Adolescent ; Botulinum Toxins ; administration & dosage ; therapeutic use ; Cerebral Palsy ; drug therapy ; Humans ; Male ; Muscle Spasticity ; drug therapy ; Neuromuscular Agents ; administration & dosage ; therapeutic use

PURPOSE: To investigate the effect of intramuscular Botulinum toxin type A (BoNT-A) injection on gait and dynamic foot pressure distribution in children with spastic cerebral palsy (CP) with dynamic equinovarus foot. MATERIALS AND METHODS: Twenty-five legs of 25 children with CP were investigated in this study. BoNT-A was injected into the gastrocnemius (GCM) and tibialis posterior (TP) muscles under the guidance of ultrasonography. The effects of the toxin were clinically assessed using the modified Ashworth scale (MAS) and modified Tardieu scale (MTS), and a computerized gait analysis and dynamic foot pressure measurements using the F-scan system were also performed before injection and at 1 and 4 months after injection. RESULTS: Spasticity of the ankle plantar-flexor in both the MAS and MTS was significantly reduced at both 1 and 4 months after injection. On dynamic foot pressure measurements, the center of pressure index and coronal index, which represent the asymmetrical weight-bearing of the medial and lateral columns of the foot, significantly improved at both 1 and 4 months after injection. The dynamic foot pressure index, total contact area, contact length and hind foot contact width all increased at 1 month after injection, suggesting better heel contact. Ankle kinematic data were significantly improved at both 1 and 4 months after injection, and ankle power generation was significantly increased at 4 months after injection compared to baseline data. CONCLUSION: Using a computerized gait analysis and foot scan, this study revealed significant benefits of BoNT-A injection into the GCM and TP muscles for dynamic equinovarus foot in children with spastic CP.
Adolescent ; Ankle Joint ; Botulinum Toxins, Type A/administration & dosage/*pharmacology ; Cerebral Palsy/*complications/drug therapy ; Child ; Child, Preschool ; Clubfoot/*drug therapy/*etiology/physiopathology ; Female ; Foot ; Gait/*drug effects/physiology ; Humans ; Injections, Intramuscular ; Male ; Muscle Spasticity/drug therapy ; Muscle, Skeletal/diagnostic imaging ; Neuromuscular Agents/administration & dosage/*pharmacology ; Pressure ; Prospective Studies ; Treatment Outcome ; Weight-Bearing

OBJECTIVETo investigate the long-term clinical efficacy and adverse effects of botulinum toxin-A (BTX-A) injection in the treatment of gastrocnemius spasticity in children aged 9-36 months with cerebral palsy.

METHODSEighty children aged 9-36 months with cerebral palsy and gastrocnemius spasticity were selected and randomly divided into a BTX-A injection group and a conventional treatment group (n=40 each). The children in the BTX-A injection group received injections of BTX-A guided by color Doppler ultrasound and 4 courses of rehabilitation training after injection. Those in the conventional treatment group received 4 courses of the same rehabilitation training alone. Before treatment and at 1, 2, 3, and 6 months after treatment, the modified Tardieu scale (MTS) was applied to assess the degree of gastrocnemius spasticity, the values in the passive state measured by surface electromyography (sEMG) were applied to evaluate muscle tension, and the Gross Motor Function Measure (GMFM) was used to evaluate gross motor function.

RESULTSCompared with the conventional treatment group, the BTX-A injection group had significantly greater reductions in MTS score and the values in the passive state measured by sEMG (P<0.05), as well as significantly greater increases in joint angles R1 and R2 in MTS and gross motor score in GMFM (P<0.05). No serious adverse reactions related to BTX-A injection were found.

CONCLUSIONSBTX-A injection is effective and safe in the treatment of gastrocnemius spasticity in children aged 9-36 months with cerebral palsy.

Botulinum Toxins, Type A ; administration & dosage ; Cerebral Palsy ; drug therapy ; physiopathology ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Muscle Spasticity ; drug therapy ; physiopathology ; Muscle, Skeletal ; drug effects ; physiopathology ; Prospective Studies ; Treatment Outcome

Intravesical onabotulinumtoxinA (BoNT-A) injection is an effective treatment for overactive bladder syndrome (OAB) that is refractory to antimuscarinics. An injectable dose of 100 U has been suggested to achieve the optimal balance of benefit and safety in patients with OAB. BoNT-A (total volume of 10 mL) was administered as evenly distributed intradetrusor injections (5 U) across 20 sites approximately 1 cm apart (0.5 mL per site) using a flexible or rigid cystoscope. Treatment with BoNT-A was generally well tolerated by most patients, and most treatment-related adverse events were localized to the urinary tract. The prevalence of OAB increases with age, and elderly patients are more vulnerable to complications. The short-term efficacy of intravesical BoNT-A injection for refractory OAB with no treatment-related complications in the elderly population has been documented. Frail elderly patients can experience the same treatment results, such as significantly improved urgent urinary incontinence and quality of life, as young and nonfrail elderly patients with 100-U BoNT-A injections. However, increased risk of larger postvoid residual (PVR) urine and lower long-term success rates were noted in frail elderly patients; around 11% had acute urinary retention, while 60% had PVR urine volume >150 mL after treatment. In addition, intravesical injection of BoNT-A effectively decreased urgency symptoms in elderly patients with OAB and central nervous system lesions. The adverse effects were acceptable, while the long-term effects were comparable to those in patients with OAB without central nervous system lesions. Nonetheless, the possibility of longstanding urinary retention and chronic catheterization in this vulnerable population requires careful evaluation before treatment with intravesical BoNT-A. In conclusion, the current findings indicate that intravesical BoNT-A is an effective and safe treatment for OAB in elderly patients.
Administration, Intravesical ; Aged ; Botulinum Toxins, Type A ; Catheterization ; Catheters ; Central Nervous System ; Cystoscopes ; Frail Elderly ; Humans ; Muscarinic Antagonists ; Prevalence ; Quality of Life ; Urinary Bladder, Overactive* ; Urinary Incontinence ; Urinary Retention ; Urinary Tract ; Vulnerable Populations

OBJECTIVETo investigate the application of facial liposuction and fat grafting in the remodeling of facial contour.

METHODSFrom Nov. 2008 to Mar. 2014, 49 cases received facial liposuction and fat grafting to improve facial contours. Subcutaneous facial liposuction with tumescent technique and chin fat grafting were performed in all the cases, buccal fat pad excision of fat in 7 cases, the masseter injection of botulinum toxin type A in 9 cases, temporal fat grafting in 25 cases, forehead fat grafting in 15 cases.

RESULTSMarked improvement was achieved in all the patients with stable results during the follow-up period of 6 - 24 months. Complications, such as asymmetric, unsmooth and sagging were retreated with acceptance results.

CONCLUSIONCombination application of liposuction and fat grafting can effectively and easily improve the facial contour with low risk.

Adipose Tissue ; transplantation ; Botulinum Toxins, Type A ; administration & dosage ; Chin ; Face ; surgery ; Forehead ; Humans ; Injections, Intramuscular ; Lipectomy ; adverse effects ; methods ; Masseter Muscle ; Neuromuscular Agents ; administration & dosage

Achalasia is an esophageal motility disorder that is commonly misdiagnosed initially as gastroesophageal reflux disease. Patients with achalasia often complain of dysphagia with solids and liquids but may focus on regurgitation as the primary symptom, leading to initial misdiagnosis. Diagnostic tests for achalasia include esophageal motility testing, esophagogastroduodenoscopy and barium swallow. These tests play a complimentary role in establishing the diagnosis of suspected achalasia. High-resolution manometry has now identified three subtypes of achalasia, with therapeutic implications. Pneumatic dilation and surgical myotomy are the only definitive treatment options for patients with achalasia who can undergo surgery. Botulinum toxin injection into the lower esophageal sphincter should be reserved for those who cannot undergo definitive therapy. Close follow-up is paramount because many patients will have a recurrence of symptoms and require repeat treatment.
Botulinum Toxins/administration & dosage ; Deglutition Disorders/etiology ; Diagnostic Errors ; Endoscopy, Digestive System ; Esophageal Achalasia/*diagnosis/etiology/physiopathology/therapy ; Esophageal Sphincter, Lower ; Esophagus/physiopathology/surgery ; Gastroesophageal Reflux/diagnosis ; Humans ; Injections, Subcutaneous ; Manometry ; Neurotransmitter Agents/administration & dosage ; Recurrence