Prophylaxis of Recurring Low-Flow Priapism: Experimental Botulinum Neurotoxin Injection into the Ischiocavernosus Muscle

The document discussed the case of a 31-year-old man with recurring low-flow priapism, unresponsive to usual medications. Treatment with cyproterone acetate stopped spontaneous erections but caused significant side effects, including erectile impotence, reduced motivation, decreased interest in sex, weight gain, breast enlargement, touch sensitivity, and hair loss on his legs. The patient also experienced painful pelvic muscle cramps. After being informed, he agreed to botulinum neurotoxin injections into the ischiocavernosus muscles to reduce muscle tone and improve venous drainage. This treatment successfully prevented priapism relapses for over 6 months.