Autologous Platelet-Rich Plasma
is a novel management technique of Erectile Dysfunction
Erectile dysfunction or inability to achieve and maintain erections suitable for intercourse represents the big concern among men. Even in advanced age the intimacy is considered to be a very important part of functional life. Nearly 500,000 men in the age between 50 and 69 developed Erectile Dysfunction every year and even for men in their 40’s the incidence of ED exceeds 30%. The advanced basic and pharmaceutical research of last decades showed that the main cause of impotence is underlying vascular disease and this condition is closely associated with coronary artery disease, stroke, hypertension. Improvement in erectile function may be achieved through various lifestyle changes including weight loss, exercise, and smoking cessation. Hypogonadism or low serum testosterone levels may cause symptoms of poor erections along with decreased libido but testosterone replacement alone is usually not the most effective ED treatment. Currently, there are several broad categories of ED treatment. Oral medications including PDE5 inhibitors (sildenafil, vardenafil, tadalafil, and avanafil) are an attractive option for most patients given the ease of administration, have been introduced to the clinical practice, since the approval of sildenafil in 1998, have a similar mechanism of action and comparable efficacy. Vacuum erection devices with a constriction ring use negative pressure to increase arterial flow to the penis and decrease venous outflow to induce erection. Intracavernosal injections (alprostadil, phentolamine, papaverine, and/or atropine) or intraurethral suppositories (alprostadil) are alternatives in patients who are non-responders to oral medications, have adverse effects, or have contraindications to PDE5 inhibitors. Penile implants are the most invasive treatment, but provide durable results and have the highest satisfaction rates of all of treatments.
Given the prevalence and impact of ED, diagnosis and treatment has a considerable burden on the healthcare system, with conservative estimates placing the cost of ED treatment nationwide at $15 billion annually. There is significant financial incentive to find more effective and less invasive ED treatments. However, relatively few groundbreaking treatments have been identified in the last decade. Among the most promising modality in non-surgical ED management are gene therapy, platelet-rich plasma (PRP), and extracorporeal low-intensity shockwave therapy (LiSWT).
Autologous Platelet-Rich Plasma
Platelets have a pivotal role in the inflammatory response, tissue remodeling, and angiogenesis. The use of autologous platelet-rich plasma (PRP) has been explored in the treatment of a number of medical conditions, including heart disease, arthritis and cosmetics. A blood sample is obtained through venipuncture and which is then centrifuged to remove inflammatory cells and red blood cells. The supernatant contains platelets and plasma proteins, including growth factors and other components that are important for healing. The supernatant is directly injected into the target area. For ED, injections are performed directly into the corpus cavernosum. The most convincing data on PRP for ED came from in an animal model on male rats that were divided in 3 groups: (1) sham surgery, (2) bilateral cavernosal nerve crush injury and intracavernosal injection of normal saline, and (3) bilateral cavernosal nerve crush injury and intracavernosal injection of PRP. Rats treated with saline or PRP were treated immediately after the nerve injury. When comparing the saline vs. the PRP cohorts, the authors were able to demonstrate a significant improvement in return of erectile function with higher in the corpus cavernous after electrical nerve stimulation and significant preservation of neural tissue with the PRP cohort compared with the saline control. This study suggested PRP as a novel therapeutic for ED. However, no studies evaluating efficacy of PRP for ED in humans are currently available. The safety of PRP has been suggested in a study by Matz et al. where PRP fibrin matrix was used in 16 patients for ED and/or Peyronie’s disease, with no major complications and with minor complications such as mild pain or bruising at the injection site in approximately 20% of patients. Although PRP is an interesting potential therapy for ED, further studies are warranted to evaluate safety and efficacy. So far despite the wide spread use of this technique in the management of various conditions and very promising animal studies results, PRP is considered to be an experimental therapy for ED by AUA and Society of sexual Medicine.