Low-intensity shockwave therapy, plasma injections efficacious for erectile dysfunction

David E. Hinojosa-Gonzalez, MD

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Regenerative treatment including low-intensity shockwave therapy (LiWST) and platelet-rich plasma (PRP) injections, as well as a combination of both, may be efficacious for the treatment of erectile dysfunction (ED).

In new systematic review and meta-analysis data presented at the Sexual Medicine Society of North America (SMSNA) 2024 Fall Scientific Meeting in Scottsdale, AZ this week, a team of Texas-based investigators reported that both LiWST and PRP were independently and in combination associated with significantly improved International Index of Erectile Function (IIEF) scores versus control therapy. The findings highlight the opportunity available with regenerative therapy strategy, pending further analyses.

The team, led by David E. Hinojosa-Gonzalez, MD, of the Scott Department of Urology at Baylor College of Medicine, conducted their analysis to compare the efficacy of PRP injections, LiSWT, and stem cell therapy in treating ED per IIEF scores.

“Current guidelines advocate a shared decision-making process approach to ED management,” investigators wrote. “There is growing interest in regenerative therapies such as stem cell therapy, PRP injections, and LiSWT for ED. However, comparative data on the efficacy of these modalities are limited.”

Hinojosa-Gonzalez and colleagues conducted a their systematic search of relevant clinical databases to derive ED treatment outcomes with PRP, LiSWT and stem cell therapy in January 2024. All included articles required reported outcomes for IIEF.The team used data to interpret mean differences in treatment-based outcomes.

The final analysis included 16 studies with 907 patients. Among them, 370 patients received LiSWT, 100 received PRP, 10 received stem cell therapy, and 427 patients served as control.

Investigators observed that LiSWT was the most efficacious lone treatment of those assessed, being associated a mean difference score of 3.4 on IIEF versus control therapy (95% CI, 2.1 – 4.9). PRP was associated with a mean difference of 3.2 (95% CI, 0.58 – 5.8), and combination PRP plus LiSWT was associated with a mean difference of 8.2 (95% CI, 3.8 – 13.0).

Though stem cell therapy was associated with a mean difference of 4.3 versus control on IIEF outcomes, the difference was not statistically significant due to the limited patient data (95% CI -1.1 to 9.7).

In assessing specific regimens of regenerative treatment, investigators observed 3 that which significantly improved IIEF versus control in patients with ED:

• LiSWT 0.09 mJ/mm2 (3.0; 95% CI, 1.3 – 4.8)
• LiWST 0.15 mJ/mm2 (5.4; 95% CI, 2.5 – 8.6)
• LiSWT 0.15 mJ/mm2 plus once-weekly PRP (10.0; 95% CI, 16.0)

A further meta-regression analysis adjusting for the administration of PDE5 inhibitors with regenerative therapy showed non-significant results for improved IIEF scores versus control.

Overall, the findings complement prior research highlighting the safety of combination LiSWT plus PRP injections for the treatment of ED, and provide investigators evidence to further analyze outcomes with this combination of regenerative therapy in clinical trials.

“The findings suggest that PRP and LiSWT…may offer improvements in erectile function, though the clinical relevance and extent of their impact remain questionable,” Hinojosa-Gonzalez and colleagues wrote. “Further research is necessary to determine the efficacy of stem cell therapies for erectile function.”

References

1. ^{Hinojosa-Gonzalez D, Saffati G, Orozco Rendon D, La T, et al. Regenerative Therapies for Erectile Dysfunction: A Systematic Review, Bayesian Network Meta-Analysis, and Meta-Regression. Paper presented at: Sexual Medicine Society of North America (SMSNA) 2024 Fall Scientific Meeting. Scottsdale, AZ. October 17 – 21, 2024.}
2. ^{Broderick JM. Combo of shockwave therapy and platelet rich plasma safe for ED, but efficacy is unclear. Urology Times. Published May 5, 2024. https://www.urologytimes.com/view/combo-of-shockwave-therapy-and-platelet-rich-plasma-safe-for-ed-but-efficacy-is-unclear}