What is erectile dysfunction?
What are the common treatments for erectile dysfunction?
Regenerative therapies for erectile dysfunction
platelet-rich plasma
Low intensity extracorporeal shock wave therapy
Stem cell therapy
Amniotic fluid matrices
References
Further reading


Erectile dysfunction is a common sexual abnormality in men. The condition is characterized by the inability to achieve or maintain an erection during sexual activity. New regenerative therapies have shown promising results in restoring the structure and function of affected erectile tissues.

Image Credit: dokurose/Shutterstock.com

What is erectile dysfunction?

Erectile dysfunction is a very common health problem that affects the quality of life of patients and their partners. About 30% to 65% of men between the ages of 40 and 80 in the general population currently suffer from erectile dysfunction. By 2025, the disease is expected to affect up to 322 million men worldwide.

The most common symptoms of erectile dysfunction are the inability to get or keep an erection and reduced sex drive. The condition can be induced by certain cardiovascular, metabolic and neurological diseases. Excessive consumption of alcohol, smoking and certain medications can also cause erectile dysfunction. In addition to these physical causes, certain psychological factors, including stress, anxiety, depression and relationship problems, can induce erection problems.

What are the common treatments for erectile dysfunction?

The most common and conventional treatment for erectile dysfunction is the oral administration of phosphodiesterase type 5 inhibitors. This drug is very effective in treating mild to moderate erectile dysfunction. A serious condition often requires more invasive treatments, including intracavernous injections and implantation of a penile prosthesis. However, these treatments are very expensive and carry risks of complications and side effects related to surgery.

Regenerative therapies for erectile dysfunction

Regenerative medicine is considered a promising therapeutic approach for erectile dysfunction. These therapies aim to restore erectile function by regenerating damaged nerves and muscles, as well as regulating the expression of growth factors. Regenerative therapies currently used to treat erectile dysfunction include platelet-rich plasma, amniotic fluid matrices, low-intensity extracorporeal shock wave therapy, and stem cell therapy.

Image Credit: Lightspring/Shutterstock.com

Image Credit: Lightspring/Shutterstock.com

platelet-rich plasma

Platelet-rich plasma contains 4 times more platelets than normal. It is highly enriched with various growth factors, including vascular endothelial growth factor, epidermal growth factor, insulin-like growth factor, platelet-derived growth factor, and fibroblast growth factor. Growth factors and other biologically active components of platelet-rich plasma are known to improve erectile functions through the endothelial nitric oxide synthase (eNOS) pathway. Importantly, studies have linked platelet-rich plasma therapy to nerve regeneration.

Phase I human clinical trials have indicated that intracavernous injections of platelet-rich plasma in patients with erectile dysfunction do not cause major adverse effects, with the exception of penile bruising which has been observed in 40% patients. In terms of effectiveness, the therapy appears to result in a moderate improvement in erectile dysfunction.

Low intensity extracorporeal shock wave therapy

Low intensity extracorporeal shock wave therapy improves erectile dysfunction by stimulating the formation of new blood vessels (angiogenesis). In this approach, an energy source (electrohydraulic, electromagnetic, or piezoelectric) is used to generate shock waves that transfer energy to affected tissue to directly induce mechanical stress.

Several animal studies have shown that the therapy improves erectile functions by improving microcirculation, recruiting progenitor cells and stem cells, increasing blood nitric oxide levels through vasodilation, and causing nerve regeneration.

In human clinical trials, the therapy has been found to improve erectile functions in patients with mild, moderate, or severe erectile dysfunction who are unresponsive to phosphodiesterase type 5 inhibitors. In contrast, it There are clinical trials showing no therapeutic benefit of this intervention.

Stem cell therapy

The property of self-renewal and the ability to differentiate into a variety of cell types has made stem cells an attractive choice for treating erectile dysfunction. Mesenchymal stem cells derived from bone marrow or adipose tissue can promote tissue regeneration by releasing growth factors, chemokines and cytokines. This approach has been considered for the treatment of patients with erectile dysfunction.

Treatment of patients with erectile dysfunction with stem cells derived from umbilical cord blood and phosphodiesterase type 5 inhibitors has been shown to result in significant improvement in erectile function and morning erection. Similar effects were observed after combined treatment with adipose tissue-derived stem cells and platelet lysate.

EAU TV: Stem cells have been shown to restore erection ability in men with erectile dysfunction

Long-term improvement in erectile function has been observed in patients treated with autologous stem cells derived from adipose tissue. A 6-month treatment results in a significant improvement in penetrative sex in patients even in the absence of any oral medication.

Regarding the route of administration of stem cells, intravenous injection is less invasive and causes less morbidity. However, in most clinical trials, intracavernous injection has been used to administer stem cells.

Amniotic fluid matrices

The dehydrated human amniotic membrane is a rich source of neurotrophic factors, growth factors, cytokines, and anti-inflammatory and anti-fibrotic factors. These membranes are currently used as a new nerve regeneration strategy to treat erectile dysfunction.

Results from human clinical trials have indicated that treatment with amnion grafts is beneficial for early recovery of erectile function. However, the treatment does not appear to result in long-term benefits.

References[if–>

• Dyserection. 2021. Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776
• Campbell, JD (2020). The good, bad and ugly of regenerative therapies for erectile dysfunction. Translational Andrology and Urology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108995/
• Ryu, J. (2012). Regenerative technology for future erectile dysfunction therapy. Translational Andrology and Urology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708247/
• Liu, JL (2021). Restorative Therapies for Erectile Dysfunction: Sexual Medicine Society of North America (SMSNA) Position Statement. Sexual Medicine. https://www.sciencedirect.com/science/article/pii/S2050116121000234

Further reading