Clinical efficacy of intracavernous injection of platelet lysate for erectile dysfunction

Abstract

Background: Among the emerging treatments for erectile dysfunction (ED), platelet-rich plasma (PRP), known for its ability to enhance tissue repair and regeneration, stands out as a promising therapeutic approach. In this innovative study, we aimed to assess the efficacy of intracavernous injections of platelet lysate (PL), a derivative of PRP, in improving erectile function among ED patients.

Methods: We enrolled twenty-six patients, aged between 35 and 70 years (mean age 51.6 ± 11.3 years), who had been experiencing ED for over six months and had an International Index of Erectile Function-5 (IIEF-5) score of 21 or less. Participants received autologous PL injections intracavernously every two weeks for a total of five administrations. We assessed Erection Hardness Score (EHS) and International Index of Erectile Function-5 (IIEF-5) bi-weekly for 16 weeks and conducted penile Doppler ultrasounds pre- and post-treatment to record peak systolic velocity (PSV) and resistance index (RI).

Results: Before treatment, the mean EHS was 2.15 ± 0.88 and IIEF-5 was 10.92 ± 5.28. Remarkable improvements were observed post-treatment, with the EHS significantly increasing to 3.15 ± 0.83 (p < 0.05) and IIEF-5 to 17.23 ± 5.26 (p < 0.05). Penile Doppler ultrasound exhibited an increase in both PSV and RI post-treatment, with the rise in RI being statistically significant.

Conclusions: Our findings indicate that intracavernous injections of PL substantially enhance erectile function, as evidenced by improvements in EHS, IIEF-5, and the RI of penile Doppler ultrasound, without hemorrhagic events or other adverse reactions apart from temporary pain at the injection site during the 16-week follow-up period. These encouraging results suggest that PL injections are a safe and effective treatment modality for patients with moderate ED, potentially providing a less invasive and more physiologically friendly alternative to current ED management strategies.

Trial registration: The study received approval from the Institutional Review Board of National Taiwan University Hospital (IRB Number 202008061RIPC, date of registration 08/28/2020).

Keywords: Erectile dysfunction; Intracavernous injection; Platelet lysate; Platelet-rich plasma.

Fig. 1

Flow diagram regarding the experimental procedure and criteria of inclusion and exclusion

Fig. 2

Schematic representative of platelet lysate (PL) injections. Six Injection sites viewed from underneath of penis indicate by syringe icons (A). Injection is shown in cross-section view of penis (B)

Fig. 3

Doppler ultrasound Images of vascular flow in penis

Fig. 4

International Index of Erectile Function (IIEF-5) (A) and Erection Hardness Score (EHS) (B) scores on week 0 and 16 after PL injections

Fig. 5

EHS scores on week 0, 2, 4, 6, 8 and 16 after PL injections

Fig. 6

Scores to question 1 to 5 in IIEF-5 questionnaire on week 0, 2, 4, 6, 8 and 16 after PL injections (A, B, C, D, and E)

Fig. 7

IIEF-5 questionnaire scores at weeks 0, 2, 4, 6, 8, and 16 following PL injections in patients with mild, moderate, or severe ED. Values represent the mean ± SEM for n = 11, 9, and 6 in patients with mild, moderate, or severe ED, respectively. Symbols a, b, and c indicate P < 0.05 when compared to week 0 scores in patients with mild, moderate, or severe ED, respectively