Botulinum toxin a combined with penile traction therapy for the treatment of penile retraction: a retrospective single-arm pilot study.

Abstract

This retrospective single-arm pilot study evaluated a novel minimally invasive approach combining Botulinum Toxin A injection with penile traction therapy for the treatment of penile retraction. This study was conducted in 168 men with retractile penis treated between October 2023 and June 2025. Flaccid penile length was measured in the standing position with the penis in a naturally dependent state after a resting period in a room-temperature environment, using a rigid ruler from the pubic symphysis to the tip of the glans with compression of the suprapubic fat pad. Psychological outcomes were assessed using the Self-Esteem and Relationship questionnaire and the Index of Male Genital Image, while erectile function was evaluated using the five-item International Index of Erectile Function. Mean baseline flaccid penile length was 4.4  ±  0.66 cm, increasing significantly to 6.9  ±  0.81 cm at 6 months (P < 0.001). Improvements were also observed under thermal stimulation and in the penile retraction reduction ratio, which decreased from 27.3-11.6% at 6 months (P < 0.001). Erectile penile length and five-item International Index of Erectile Function scores showed no significant changes. Psychological outcomes improved significantly, with Self-Esteem and Relationship and Index of Male Genital Image scores increasing from 28.8  ±  4.3 and 39.3  ±  5.7-54.4  ±  5.6 and 59.0  ±  7.3, respectively (P < 0.001). Mild transient injection-site pain occurred in 11.3% of patients without other complications. This combined therapy may represent a feasible minimally invasive option for selected patients with penile retraction and reduced visible flaccid penile exposure. However, it does not confer true anatomical penile elongation, and given the exploratory single-arm design, the findings should be interpreted with caution. Further prospective randomized controlled studies using standardized penile measurements and longer follow-up are needed to clarify the durability of treatment effects and the independent contribution of each treatment component.