PRP, P-Shot, Priapus Shot: Is it an effective treatment for ED?

What is erectile dysfunction (ED)?

Erectile dysfunction (ED) is a condition when a man cannot obtain or maintain an erection firm enough for sufficient sexual intercourse. It is a common concern among men and affects about 50% of men aged 50 and above.¹ Not only does ED affect our quality of life, it is also associated with an increased risk of cardiovascular disease, stroke, hypertension and diabetes.^2,3 Appropriately treating of ED offers an opportunity to improve a man’s health in multiple ways.

What is platelet-rich plasma (PRP) and how is it used for ED?

Platelets play a crucial role in our body’s inflammatory response, tissue remodeling and angiogenesis [formation of new blood vessels]. The use of autologous [obtained from the same individual] platelet-rich plasma (PRP) is an emerging treatment for ED. Firstly, a blood sample is obtained from the patient. This sample is centrifuged [a type of processing] until only a fluid, called supernatant, containing platelets and plasma proteins, remain. These plasma proteins consist of growth factors essential for tissue restoration. This supernatant is subsequently injected directly into the corpus cavernosum of the penis in ED patients, which can aid in the healing process through repairing of damaged tissue and cell proliferation.⁴

What studies exist supporting the use of PRP for ED?

To date, there are very minimal studies evaluating the safety and efficacy of PRP as a treatment for ED. Only 3 animal studies have demonstrated the application of PRP to facilitate nerve regeneration and erectile function recovery.^5–7 Moreover, there have only been 2 human studies evaluating the safety, but not the efficacy, of PRP.^8,9 The safety of PRP has been suggested in the study by Matz et al. in 2018 where PRP fibrin matrix was used in 5 patients, with no major complications and with minor complications such as pain or bruising at the injection sites occurring in 20% of patients.⁸ These studies are not without its limitations. First, these studies only evaluated a small number of participant. Theses studies were also not the best designed study as they did not include appropriate groups to compare PRP therapies to currently approved therapies. Furthermore, the lack of a common PRP protocol on the duration and frequency of treatment is also considered a limitation.

What are the recommendations from the American Urological Association and Sexual Medicine Society of North America?

According to the current American Urological Association (AUA) and Sexual Medicine Society of North America (SMSNA) guidelines for ED, the expert opinion consensus is that PRP therapy should not be offered to men with ED, unless it is administered in the context of an approved experimental clinical research study.¹⁰ Unfortunately, this therapy is still directly advertised to consumers and is readily available for purchase often requiring upfront cash payments. As there are currently no studies available to constitute a strong evidence base, reliable information regarding the potential risks and benefits of PRP therapy is still unavailable. Hence, it is necessary to conduct larger clinical trials to confirm the effectiveness of PRP prior to it being recommended widely to patients.

Are there proven methods to effectively to treat ED?

Several effective and proven treatment options exist to treat ED. These treatments include oral medications, penile injections, vaccuum erection devices, and penile implants. Schedule an appointment with Dr. Chung to receive an in-depth evaluation of your history and symptoms to find the best treatment option for you.

References

1. Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J. Urol. 2000;163(2):460-463.
2. Dong J-Y, Zhang Y-H, Qin L-Q. Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J. Am. Coll. Cardiol. 2011;58(13):1378-1385. doi:10.1016/j.jacc.2011.06.024.
3. Böhm M, Baumhäkel M, Teo K, et al. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) Trials. Circulation 2010;121(12):1439-1446. doi:10.1161/CIRCULATIONAHA.109.864199.
4. Patel DP, Pastuszak AW, Hotaling JM. Emerging Treatments for Erectile Dysfunction: a Review of Novel, Non-surgical Options. Curr Urol Rep 2019;20(8):44. doi:10.1007/s11934-019-0908-2.
5. Wu C-C, Wu Y-N, Ho H-O, Chen K-C, Sheu M-T, Chiang H-S. The neuroprotective effect of platelet-rich plasma on erectile function in bilateral cavernous nerve injury rat model. J. Sex. Med. 2012;9(11):2838-2848. doi:10.1111/j.1743-6109.2012.02881.x.
6. Wu Y-N, Wu C-C, Sheu M-T, Chen K-C, Ho H-O, Chiang H-S. Optimization of platelet-rich plasma and its effects on the recovery of erectile function after bilateral cavernous nerve injury in a rat model. J Tissue Eng Regen Med 2016;10(10):E294-E304. doi:10.1002/term.1806.
7. Ding X-G, Li S-W, Zheng X-M, Hu L-Q, Hu W-L, Luo Y. The effect of platelet-rich plasma on cavernous nerve regeneration in a rat model. Asian J Androl 2009;11(2):215-221. doi:10.1038/aja.2008.37.
8. Matz EL, Pearlman AM, Terlecki RP. Safety and feasibility of platelet rich fibrin matrix injections for treatment of common urologic conditions. Investig. Clin. Urol. 2018;59(1):61-65. doi:10.4111/icu.2018.59.1.61.
9. Epifanova MV, Chalyi ME, Krasnov AO. [Investigation of mechanisms of action of growth factors of autologous platelet-rich plasma used to treat erectile dysfunction]. Urologiia 2017;(4):46-48.
10. Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J. Urol. 2018;200(3):633-641. doi:10.1016/j.juro.2018.05.004.

Author

Paul H. Chung, MD Paul H. Chung, MD is Assistant Professor of Urology and Director of Reconstructive Urology at the Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA