What is the role of restorative therapies in the treatment of erectile dysfunction (ED)?

Updated: Oct 14, 2020
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

One direction of research into treatment of ED focuses on restoration of the structure and function of dysfunctional erectile tissue, rather than simply relief of symptoms. These techniques, termed regenerative therapy, include the following [115] :

  • Low-intensity extracorporeal shockwave therapy
  • Stem cell therapy
  • Intracavernous injection of platelet-rich plasma
  • Amniotic fluid matrices (wrapping of dehydrated human amnion/chorion membranes around the neurovascular bundle during radical prostatectomy)

A consensus statement from the Sexual Medicine Society of North America recommends that these novel technologies are experimental and should be used only in the context of clinical trials. [116] Nevertheless, men’s health clinics are increasingly offering such treatments, often at exorbitant cost. [115]

Low-intensity extracorporeal shock wave therapy

Although not approved for this indication in the United States, low-intensity extracorporeal shock wave therapy (LiESWT) has proved effective in European patients with severe ED that is unresponsive to treatment with PDE5 inhibitors. [117] Evaluation of LiESWT trials is complicated by their heterogeneity; they have used a variety of devices and a wide range of applied energies, number of shocks per session, and frequency and total number of sessions. [118]

LiESWT may have immediate effects, presumably from activation of nitric oxide–mediated vasodilation and increased arterial inflow. Mid- and long-term effects appear to involve penile revascularization, recovery/regeneration of penile nerves, and improvement in cavernosal tissue structure and function. [118]

Stem cell therapy

Phase I and II clinical trials of stem cell therapy for ED have for the most part shown promising results, with positive effects on erectile function and no serious adverse effects. [119, 120] However, several aspects of this approach remain unsettled: The choice between autologous or allogeneic cells remains uncertain, as does dosing, and although intracavernous injection is the administration route most used, intravenous injection causes less morbidity and is less invasive. [115]


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