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. 2025 Apr;43(2):359-375.
doi: 10.5534/wjmh.240086. Epub 2024 Jul 12.

Regenerative Therapy in Erectile Dysfunction: A Survey on Current Global Practice Trends and GAF Expert Recommendations

Manaf Al Hashimi  1   2   3 , Germar-M Pinggera  3   4 , Taymour Mostafa  3   5 , Amarnath Rambhatla  3   6 , Taha Hamoda  3   7   8 , Rupin Shah  3   9 , Eric Chung  3   10 , Ahmed Harraz  3   11   12   13 , Mohamed Arafa  3   5   14   15 , Tuncay Toprak  3   16 , Omer Raheem  3   17 , Carlo Giulioni  3   18 , Ponco Birowo  3   19 , Luca Boeri  3   20 , Yassir Jassim  3   21 , Priyank Kothari  3   22 , Ranjit Vishwakarma  3   9 , Bahadir Sahin  3   23 , Widi Atmoko  3   19 , Safar Gamidov  3   24 , Cesar Rojas-Cruz  3   25 , Darren Katz  3   26   27   28 , Adriano Fregonesi  3   29 , Nazim Gherabi  3   30 , Armand Zini  3   31 , Christopher Chee Kong Ho  3   32 , Mohamed S Al-Marhoon  3   33 , Marlon Martinez  3   34 , Giorgio Ivan Russo  3   35 , Ayman Rashed  3   36 , Gian Maria Busetto  3   37 , Edmund Ko  3   38 , Hyun Jun Park  3   39   40 , Selahittin Cayan  3   41 , Ramadan Saleh  3   42 , Osvaldo Rajmil  3   43 , Dong Suk Kim  3   44 , Giovanni Colpi  3   45 , Ryan Smith  3   46 , Maged Ragab  3   47 , Ates Kadioglu  3   48 , Quang Nguyen  3   49   50 , Kadir Bocu  3   51 , Ahmed El-Sakka  3   52 , Charalampos Thomas  3   53 , Hussain M Alnajjar  3   54 , Hiva Alipour  3   55 , Ashok Agarwal  3   56
Affiliations

Regenerative Therapy in Erectile Dysfunction: A Survey on Current Global Practice Trends and GAF Expert Recommendations

Manaf Al Hashimi et al. World J Mens Health. 2025 Apr.

Abstract

Purpose: This study aimed to examine current global practices in regenerative therapy (RT) for erectile dysfunction (ED) and to establish expert recommendations for its use, addressing the current lack of solid evidence and standardized guidelines.

Materials and methods: A 39-question survey was developed by senior Global Andrology Forum (GAF) experts to comprehensively cover clinical aspects of RT. This was distributed globally via a secure online Google Form to ED specialists through the GAF website, international professional societies, and social media, the responses were analyzed and presented for frequencies as percentages. Consensus on expert recommendations for RT use was achieved using the Delphi method.

Results: Out of 479 respondents from 62 countries, a third reported using RT for ED. The most popular treatment was low-intensity shock wave therapy (54.6%), followed by platelet-rich plasma (24.5%) and their combination (14.7%), with stem cell therapy being the least used (3.7%). The primary indication for RT was the refractory or adverse effects of PDE5 inhibitors, with the best effectiveness reported in middle-aged and mild-to-moderate ED patients. Respondents were confident about its overall safety, with a significant number expressing interest in RT's future use, despite pending guidelines support.

Conclusions: This inaugural global survey reveals a growing use of RT in ED treatment, showcasing its diverse clinical applications and potential for future widespread adoption. However, the lack of comprehensive evidence and clear guidelines requires further research to standardize RT practices in ED treatment.

Keywords: Erectile dysfunction; Extracorporeal shockwave therapy; Platelet-rich plasma; Regenerative medicine; Stem cells; Surveys and questionnaires.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1. A flow diagram of the research process. GAF: Global Andrology Forum.
Fig. 2
Fig. 2. Geographical distribution of the respondents.
Fig. 3
Fig. 3. Minimal work-up pathways for erectile dysfunction (ED) diagnosis.
Fig. 4
Fig. 4. The causes of not using regenerative therapy (RT) in erectile dysfunction (ED) treatment.
Fig. 5
Fig. 5. Proportions of patients who showed objective improvement after regenerative therapy (RT).
Fig. 6
Fig. 6. The erectile dysfunction (ED) etiologies that best responded to regenerative therapy.
Fig. 7
Fig. 7. Stratification by erectile dysfunction (ED) severity clusters responding to regenerative therapy (RT).
Fig. 8
Fig. 8. Response to RT based on the patients’ age group. ED: erectile dysfunction, RT: regenerative therapy.
Fig. 9
Fig. 9. Strengths, Weaknesses, Opportunities, and Threats (SWOT) of the regenerative therapy (RT) in erectile dysfunction (ED).
Fig. 10
Fig. 10. Global Andrology Forum’s pathway in assessing the statements created regarding the use of regenerative therapy (RT) in erectile dysfunction using the Delphi approach. MSD: male sexual dysfunction.
See this image and copyright information in PMC

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References

    1. Salonia A, Bettocchi C, Capogrosso P, Carvalho J, Corona G, Hatzichristodoulou G, et al. EAU Guidelines on Sexual and Reproductive Health. European Association of Urology; 2024.
    1. McMahon CG. Current diagnosis and management of erectile dysfunction. Med J Aust. 2019;210:469–476. - PubMed
    1. Allen MS, Wood AM, Sheffield D. The psychology of erectile dysfunction. Curr Dir Psychol Sci. 2023;32:487–493.
    1. Vance G, Zeigler-Hill V, Meehan MM, Young G, Shackelford TK. Erectile dysfunction, suspicious jealousy, and partner-directed behaviors in heterosexual romantic couples. Arch Sex Behav. 2023;52:3139–3153. - PubMed
    1. Zhao B, Hong Z, Wei Y, Yu D, Xu J, Zhang W. Erectile dysfunction predicts cardiovascular events as an independent risk factor: a systematic review and meta-analysis. J Sex Med. 2019;16:1005–1017. - PubMed