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146 The Efficacy of Platelet-Rich Plasma (PRP) as a Supplemental Therapy for the Treatment of Erectile Dysfunction (ED): Initial Outcomes
... During this period, further work was presented that supported the safety and efficacy of PRP in conjunction with traditional therapies for ED. [40][41][42] Importantly, these early clinical studies were limited by the absence of a placebo group, no long-term follow-up, and small sample sizes. ...
Introduction
Erectile dysfunction (ED) is the inability to achieve or maintain erection for satisfactory sexual performance. ED drastically reduces the quality of life for men and their partners and is commonly linked to comorbid conditions such as diabetes and cardiovascular disease. As a result, clinicians and researchers are working to improve treatments for ED. Current guideline-approved ED treatments include oral phosphodiesterase type 5 inhibitors, intraurethral alprostadil, penile intracavernosal injections, and penile prosthesis surgery. Today, there is increasing interest in restorative therapies such as intracavernosal platelet-rich plasma (PRP) for the management of ED.
Objectives
This narrative review describes the current trials investigating intracavernosal PRP for ED and proposes future directions to increase the strength of evidence to support use of PRP in this population.
Methods
A comprehensive literature search of PubMed, Science Direct, and Scopus was performed to identify all randomized clinical trials using PRP for the treatment of ED.
Results
We identified 4 randomized clinical trials investigating the safety and efficacy of PRP for ED. We found significant heterogeneity among study protocols, including collection of PRP, dosing of PRP, and follow-up.
Conclusion
While intracavernosal PRP is considered safe, its efficacy for the management of ED remains unknown due to variability among clinical trials.
... За рубежом первые публикации о PRP-терапии в лечении эректильной дисфункции были сде-ланы C. S. Kumar (2017) [61], а также J. J. Banno и соавт. (2017) [62]. В настоящее время PRP-терапия в урологии применяется с высокой клинической результативностью при интерстициальном цистите, синдроме хронической тазовой боли, повреждениях и стриктурах уретры, повреждениях кавернозного нерва, мужской инфертильности, болезни Пейрони, недержании мочи, инфекциях мочевых путей, нефропатиях. ...
Vascular andrology, or angioandrology, was formed on the principle of an interdisciplinary approach in medicine. The object of study were pelvic varicose veins, arteriovenous conflicts, chronic pelvic pain syndrome, erectile dysfunction, prostatic hyperplasia and lower urinary tract symptoms. New approaches developed within this scientific and clinical direction have significantly improved the results of treatment of urological and andrological patients.
... Средний балл МИЭФ-5 перед началом терапии составлял 15,6 (12 -20), а через 4 недели после введения PRP - 19,9 (11 -27). Величина эффекта по Коэну была оценена как сильная (d = 0,793), однако t-критерий не показал существенной разницы показателя в двух контрольных точках (p = 0,157) [34]. ...
Platelet-rich plasma (PRP) is one of the most common and practicable plasma-therapy techniques. The wide therapeutic range for the use of this technique in various medical fields is due to its high content of growth factors, cytokines, and chemokines. The property of PRP to induce tissue regeneration is particularly highlighted, which is used actively for the treatment of a broad range of urological diseases. The review aimed to highlight the accumulated material on the topic of the use of autologous biomaterials based on blood in urology. This article highlights the urgent need for further study of the prospects for the use of autoplasma technologies in wide multicenter studies.
... Similarly, Banno et al. reported on a small cohort of men within their institution who received PRP injection (one injection only) in combination with standard of care treatment (medication and vacuum therapy) for their ED (36). The effects of PRP were assessed at least 4 weeks post injection. ...
Erectile dysfunction (ED) is one of the commonest disorders in adult males and affects 12–19% of men of reproductive age. Only few studies have evaluated the impact of ED on men and couples with infertility—these studies report higher rates of ED in this sub-group of men compared to the general population, with the prevalence of ED in men diagnosed with male infertility ranging from 6.7 to 61.6%. Nevertheless, ED is considered a rare cause of male infertility, accounting for about 0.4–5% of all causes of male infertility. ED remains a poorly treated condition globally and current therapies, like oral medication, offer only temporary symptomatic relief and do not influence disease progression—patients are potentially on lifelong treatment, with ED worsening over time. In contrast, regenerative medicine may potentially reverse or halt the progression of ED processes. In this article, we review the evidence for intracavernosal injections of platelet-rich plasma (PRP) in the treatment of ED.
... This is related to a greater amounts of growth factors, in particular insulin like growth factor-1 (IGF-1), transforming growth factor β (TGF-β), platelet derived growth factor (PDGF) -isoforms AB and BB, vascular endothelial growth factor (VEGF). Banno et al. [1] and Matz EL et al. [4] used intracavernosal injections of PRP in patients with ED and showed an improved recovery of erectile function without major adverse events and complications. Unfortunately, limited and few studies have been published. ...
... This is related to a greater amounts of growth factors, in particular insulin like growth factor-1 (IGF-1), transforming growth factor β (TGF-β), platelet derived growth factor (PDGF) -isoforms AB and BB, vascular endothelial growth factor (VEGF). Banno et al. [1] and Matz EL et al. [4] used intracavernosal injections of PRP in patients with ED and showed an improved recovery of erectile function without major adverse events and complications. Unfortunately, limited and few studies have been published. ...
... Mild improvement was seen with the only minor adverse effect of mild pain and bruising at the injection site. 158 Reduced levels of circulating endothelial progenitor cells (EPCs), a type of stem cell necessary for regeneration of the vascular endothelial lining, is an independent risk factor for ED. 159 EPCs are decreased with chronic inflammation seen in diabetes, hypercholesterolemia, obesity, cardiovascular disease, and cigarette smoking. ...
Erectile dysfunction (ED) is common with aging. Formerly ED treatment was offered mainly by urologists, but the approval and widespread use of phosphodiesterase inhibitors has enabled primary care clinicians to provide targeted ED treatment. Although large, multicenter clinical trials have shown efficacy and safety with these drugs, they are ineffective in 30–35% of men, may cause sideeffects, and do not improve the underlying pathology. A thorough understanding of erectile physiology and causes of ED and a comprehensive treatment plan addressing all contributing factors may be more effective than pharmaceutical management and may improve aspects of psychological and physical health beyond erectile problems.
... Liao et al 65 Kumar 66 Banno et al 67 Alkhayal 68 Kumar 66 Virag ft al 71 ...
Introduction:
Platelet-rich plasma (PRP) found its use in treating different conditions and diseases, because concentrated plasma PRP consists of many growth factors. Their interaction with surrounding cells, intracellular matrix, and mediators at the site of injection leads to tissue regeneration. Angiogenic, vasculogenic, and regenerative effects of PRP may be used for erectile dysfunction (ED) and Peyronie's disease (PD) treatment.
Aim:
To present a current data review of preclinical and clinical trials on PRP use for treating ED and PD.
Methods:
Up-to-date literature on PRP use for ED and PD treatment was analyzed. The search was based on Pubmed, Cochrane Library, clinicaltrials.gov databases, with the following key words: "platelet-rich plasma" and/or "erectile dysfunction" and/or "Peyronie's disease" and/or "sexual dysfunction."
Main outcome measures:
The main outcome measures for preclinical trials on ED were erectile function, assessed with intracavernous pressure, and pathologic analysis of penile tissue. The main outcome measures for clinical trials on ED included penile duplex Doppler ultrasound scanning and validated questionnaires. The main outcome measures on PD were pathologic analysis of penile tissue for preclinical trials, as well as penile duplex Doppler ultrasound scanning, penile curvature angle measuring, and validated questionnaires for clinical trials.
Results:
4 preclinical and 6 clinical trials were described and analyzed in this article. Limitations for both preclinical and clinical trials included small groups, short follow-up periods, a lack of control groups or groups with placebo, and the lack of quality and quantity analysis of PRP.
Conclusion:
Available data show the lack of adverse reactions with PRP treatment. The studies that we found were limited by small groups. This is why the data on safety and effectiveness should be taken carefully. However, it is important to mention that PRP therapy has the potential for treating male sexual dysfunction and may be useful in andrology. Epifanova MV, Gvasalia BR, Durashov MA, et al. Platelet-Rich Plasma Therapy for Male Sexual Dysfunction: Myth or Reality? Sex Med Rev 2020;8:106-113.
Introduction:
There has been tremendous growth in regenerative medicine during the last decade. For erectile dysfunction (ED), after the inclusion of low-intensity shockwave therapy as a treatment modality for ED management by the European Association of Urology sexual health guidelines, intracavernosal injection of platelet-rich plasma (PRP) has gained popularity between urologists and patients as a novel ED therapeutic modality with initial promising results. However, limited clinical data exist regarding efficacy and safety in patients with ED. Furthermore, despite numerous preclinical studies in other tissues and organs, the mechanism of action for restoring erectile function remains undetermined.
Objectives:
This systematic review aims to present the current status of preclinical and clinical evidence regarding the use of PRP as treatment option for ED.
Methods:
A systematic literature search was conducted using PubMed, Cochrane, and ScienceDirect databases, until February 2023 for studies exploring the effect of PRP on ED.
Results:
We identified 517 articles, 23 of which were included in this review. These were 7 preclinical (of which 1 was a comparative trial and 6 were placebo-controlled randomized controlled trials) and 16 clinical studies (of which 1 was a comparative trial, 5 were randomized trials, and 2 were placebo-controlled randomized controlled trials). Preclinical data support the regenerative role of PRP in erectile tissue, in accordance with existing evidence in other tissues. Randomized clinical studies, as well as the first 2 available randomized, placebo-controlled clinical trials, showed promising efficacy and a lack of any adverse events.
Conclusion:
As PRP for ED is widely used worldwide, there is an urgent need for high-quality studies with long-term follow-up. Standardization of research protocols, especially on the quality of PRP preparation, is also needed.
Introduction:
Erectile dysfunction (ED) is one of the most common urologic problems in men worldwide, with an approximately high incidence rate, significantly affecting patients' quality of life and their sexual partners.
Objectives:
Due to the association of this disorder with essential diseases such as cardiovascular disease and diabetes, its prevention and treatment are vital for overall human physiologic and psychological health. Along with reviewing the history of treatment and current methods, we seek new approaches to curb this issue in the future.
Methods:
In this review, investigations were based on the focus of each section's content or conducted on an ad hoc basis. Searches were performed in Scopus and PubMed.
Results:
In recent years, many treatments for ED have been reported besides oral administration of phosphodiesterase 5 inhibitors such as sildenafil and tadalafil (approved by the Food and Drug Administration). Common oral medications, intracavernous injections, herbal therapies (eg, herbal phosphodiesterase 5 inhibitors), and topical/transdermal medications are routine ED treatment approaches. Moreover, some novel medications are innovative candidates for completing ED's treatment protocols: stem cell injection, low-intensity extracorporeal shock wave therapy, platelet-rich plasma injection, gene therapy, amniotic fluid matrices, rho-kinase inhibitors, melanocortin receptor antagonists, maxi-K channel activators (ie, large-conductance calcium-activated potassium channels), guanylate cyclase activators, and nitric oxide donors.
Conclusion:
Due to the importance of this complicated problem in men's society, a faster course of treatment trends toward new methods is needed to increase efficiency. Combining the mentioned treatments and attentively examining their efficacy through programmed clinical trials can be a big step toward solving this global problem.
Введение. За последние годы случаев обращения мужчин за медицинской помощью с целью восстановления эректильной функции становится все больше и больше. В том числе широко распространена форма ЭД нейрогенного характера, связанная с остеохондрозом, которая достаточно малоизучена и трудно поддается лечению.В связи с этим на сегодняшний день в урологической практике внедряются новые методы терапии, в том числе и применение аутоплазмы, обогащенной тромбоцитами. Эффективность применения ПРП в андрологии была доказана многочисленными исследованиями, включая работу М.Е. Чалого и М.В. Епифановой, где было изучено влияние АОТ на восстановление эректильной функции при повреждении кавернозных нервов, однако проблема лечебной помощи при ЭД на фоне остеохондрозе до сих пор не описана.Нашей целью стало определение эффективности лечения пациентов с эректильной дисфункцией нейрогенного типа на фоне остеохондроза интракавернозными и паравертебральными инъекциями аутоплазмы, обогащенной тромбоцитами.Материалы и методы: Нами было проведено исследование и лечение 70 пациентов с нейрогенной эректильной дисфункцией на фоне остеохондроза. 32 пациентам первой группы были назначены интракавернозные инъекции ПРП, ЛОД-терапия, 5 мг тадалафила и 90 мг Аркоксии на протяжении 90 дней. А 38 пациентам второй группы кроме этого также были проведены паравертебральные инъекции ПРП на протяжении того же периода времени для уменьшения корешкового синдрома. Через 2 и 10 месяцев мы сравнили отдаленные результаты.Результаты и их обсуждение: Эффективность терапии по субъективным данным (прирост баллов МИЭФ) более выражена у пациентов второй группы по сравнению с первой (на 39,8% и 54,2% от исходных значений соответственно). Результаты лечения во второй группе были гораздо лучше за счет уменьшения болевого синдрома, уменьшения дегенаративно-деструктивных изменений межпозвоночного диска и за счет этого улучшения эректильной функции y 78,3%.Выводы: для лечения эректильной дисфункции нейрогенного генеза дисков стоит рассматривать не только интракавернозные инъекции ПРП, но и также паравертебральные инъекции ПРП для устранения корешкового синдрома, который особенно выражен у пациентов с остеохондрозом и грыжами межпозвоночных дисков.
Introduction:
Erectile Dysfunction (ED) and Peyronie's Disease (PD) are debilitating medical conditions affecting patients' quality of life (QoL). Platelet-rich plasma (PRP) injections are one of the various emerging approaches proposed to treat these medical conditions.
Aim:
To describe the evidence of the potential role of PRP injections in ED and PD.
Methods:
The authors conducted a systematic review according to the PRISMA statement using the following databases in November 2019: The National Library of Medicine (PubMed), Ovid Medline, Cochrane, Scopus, Embase, and Embase classic. The search was performed using keywords drawn from studies on the use of PRP in ED and PD in clinical and preclinical studies.
Results:
Eighteen articles met the inclusion criteria for review, including 12 studies on the use of PRP in humans and 6 on the use of PRP in rats. Ten studies reported on the efficacy of PRP in ED exclusively, 7 in PD exclusively and one in both conditions. In humans, 6 and 3 studies showed promising results in PD and ED, respectively. No major complications were noted. Unwanted minor side effects were noted by studies reporting on PD, including mild penile bruising, ecchymosis, hematomas as well as transient hypotension noted in 2 out of 90 patients.
Conclusion:
PRP injections for the treatment of ED may be promising, but no recommendation can be made because of scarce evidence. Safety and effectiveness of this therapy in the treatment of ED and PD require further preclinical and clinical studies with standardized protocols to gain an adequate insight into its potential implications. Patients should be offered to be part of such trials to better understand PRP potential. MH Alkandari, N Touma, S Carrier, Platelet-Rich Plasma Injections for Erectile Dysfunction and Peyronie's Disease: A Systematic Review of Evidence. Sex Med Rev 2021;XX:XXX-XXX.
Erectile dysfunction is no longer a psychosocial problem. Nowadays, it is a marker specific for the initial stages of cardiovascular diseases. Рlatelet-rich plasma (PRP) is a new and promising method, which totally deserves to be noted by specialists. To review currently existing pre-clinical and clinical studies concerning application of PRP in erectile dysfunction published in international sources such as PubMed, Cochrane Library, Clinicaltrials.gov. The current data of preclinical and clinical studies determine the absence of PRP side effects and the effectiveness for ED treatment. PRP-therapy is a pathogenetically substantiated method of treating erectile dysfunction. The therapy is designed for repair and regeneration of endothelium, smooth muscle cells, and connective tissue. However, large, placebo-controlled, multicenter studies are needed to creation a systematic review and meta-analysis.
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