As mentioned before (https://uroprolo.blogspot.com/2023/05/can-erectile-dysfunction-be-treated.html), there are three main categories of regeneration therapies applied in the treatment of erectile dysfunction (ED) in men:
i. Low-intensity shockwave therapy (LiSWT)
ii. Platelet-rich plasma (PRP)
iii. Stem cell therapy (SCT)/stromal vascular fraction (SVF)
In our previous discussion, we covered low-intensity shockwave therapy.
This time, let's talk about platelet-rich plasma (PRP).
1. Mechanism
PRP therapy involves the extraction of the patient's own blood, which is then subjected to centrifugation to separate the plasma with an average platelet concentration 3-7 times higher than whole blood.
This concentrated plasma is then injected into the penile corpora cavernosa.
The regenerative effect of PRP is deemed to be mediated by the high concentration of platelets containing various growth factors, including VEGF, EGF, IGF-1, PDGF, and FGF.
These growth factors can trigger a cascade of tissue regeneration responses, including stem cell recruitment, angiogenesis (blood vessel formation), and neuro-regenerative effects.
2. Efficacy
Although there is less research on the use of PRP in the treatment of erectile dysfunction compared to extracorporeal shockwave therapy, existing data indicates that:
a.Overall, PRP injections had good results in terms of IIEF-5 (International Index of Erectile Function) and SEP (sexual encounter profile) scores, as well as PSV (peak systolic velocity) on penile-duplex ultrasound.
In a recent randomized placebo-controlled trial, 60 patients with mild to moderate vasculogenic ED were randomly assigned to receive two episodes 10 mL injections of PRP (n=30) or placebo (n=30) [590].
At follow-up 1, 3 and 6 months after completion of treatment, the proportion of patients who improved in the IIEF-EF score was significantly higher in the PRP treatment group.
69% (20/29) of PRP group achieved minimal clinically important differences (MCID), while only 27% (7/26) of the placebo group did (p < 0.001).
The average improvement in IIEF-EF scores after PRP treatment was 2.7 points at 1 month and 3.9 points at 6 months.
b. For those who have poor response to oral medications (PDE-5 inhibitors), PRP treatment provide an opportunity to improve
In a prospective study, patients with erectile dysfunction who do not respond to PDE-5 inhibitors were divided into diabetic group and non-diabetic group.
After receiving 3 PRP injections each, it was found that 33% of patients with diabetes and 50% of patients without diabetes were satisfied with the effect of PDE5 inhibitors.
Erectile Hardness Score (EHS) improved in 41% of the diabetic group and 66% of the non-diabetic group
Furthermore, the study also revealed a significant correlation between the control of diabetes and the pre- and post-treatment IIEF scores.
Patients with higher levels of glycated hemoglobin (HbA1C), indicating poorer diabetes control, had lower IIEF scores.
c. PRP combined with extracorporeal shockwave therapy shows better therapeutic efficacy compared to standalone shockwave therapy.
In a prospective study, patients with erectile dysfunction were divided into two groups.
One group received standalone extracorporeal shockwave therapy, while the other group received extracorporeal shockwave therapy combined with PRP injections.
The results showed significant improvements in International Index of Erectile Function (IIEF) scores and peak systolic velocity (PSV) of penile blood vessels in both groups at the 12th and 24th weeks of treatment.
However, the group receiving combined therapy demonstrated significantly greater improvements, and the trend of continuous improvement was observed from 12 to 24 weeks (while the standalone shockwave therapy group showed a plateau in results) (Note).
3. Conclusions:
In the field of regenerative medicine, PRP is an emerging and highly promising treatment.
With its abundance of growth factors and its ability to facilitate tissue regeneration and nerve repair, PRP has been extensively researched and applied in areas such as orthopedics, rehabilitation, sports medicine, plastic surgery, dermatology, and other related fields.
In recent years, it has gained increasing attention in urology as well.
In addition to treating male erectile dysfunction, PRP has also started to be used in various urological conditions such as Peyronie's Disease, urinary incontinence, interstitial cystitis, urethral strictures, genitourinary syndrome of menopause (GSM), and more.
Many conditions that were previously considered difficult to cure or even untreatable have found new possibilities with the introduction of PRP therapy.
It has not only brought new perspectives for treatment but has also brought hopes for many patients' conditions.
While more research is still needed, there is no doubt that PRP brings new hope for patients with erectile dysfunction who face challenging treatments.
(Note:
Extracorporeal shockwave therapy group:
1. IIEF scores: 14.6 (10-16) before treatment -> 17.3 (15-22) at 12 weeks -> 17.7 (15-21) at 24 weeks
2. PSV values: 26.4 ± 13.2 before treatment -> 35.7 ± 10.2 at 12 weeks -> 34.2 ± 9.7 at 24 weeks
Extracorporeal shockwave therapy + PRP group:
1. IIEF scores: 13.7 (9-16) before treatment -> 20.2 (18-23) at 12 weeks -> 21.6 (18-23) at 24 weeks
2. PSV values: 27.5 ± 11.6 before treatment -> 44.1 ± 8.4 at 12 weeks -> 49.6 ± 8.8 at 24 weeks)
References：
EAU Guidelines
https://uroweb.org/guidelines/sexual-and-reproductive-health
AUA update series, volume 41, Lesson 28
https://auau.auanet.org/US2022-28
Platelet-Rich Plasma (PRP) Improves Erectile Function: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial
https://pubmed.ncbi.nlm.nih.gov/33906807/#full-view-affiliation-1
Assessment of the intracavernosal injection platelet-rich plasma in addition to daily oral tadalafil intake in diabetic patients with erectile dysfunction non-responding to on-demand oral PDE5 inhibitors
https://pubmed.ncbi.nlm.nih.gov/35301742/
Effectiveness and safety of Platelet rich Plasma (PrP) cavernosal injections plus external shock wave treatment for penile erectile dysfunction: First results from a prospective, randomized, controlled, interventional study
https://www.researchgate.net/publication/331786056
Combined therapy for treating erectile dysfunction: first results on the use of low-intensity extracorporeal shock wave therapy and platelet-rich plasma
https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.14730
Platelet rich plasma for the management of urogynecological disorders: the current evidence
https://pubmed.ncbi.nlm.nih.gov/36036461/
http://www.tcs.org.tw/forum/forum_info.asp?/417.html
