Cell therapy is an emerging regenerative medicine technique that involves extracting and cultivating autologous cells, which are then re-injected into the patient’s body to repair or replace dysfunctional cells and tissues. It is widely applied across urology and sexual medicine, gynecology, orthopedics and sports medicine, dermatology and aesthetic medicine, dentistry and oral surgery, as well as major conditions including cancer, stroke, and spinal cord injuries.
What is PRP (Platelet-Rich Plasma)?
PRP (Platelet-Rich Plasma) therapy is a form of autologous cell therapy that has increasingly been utilized in recent years for the treatment of erectile dysfunction (ED). Its mechanism involves separating a high concentration of platelets from the patient’s own peripheral blood and injecting them back into the cavernous tissue of the penis. Platelets contain diverse growth factors that promote angiogenesis, tissue repair, and neuroregeneration, assisting in the improvement of penile blood flow and erectile function.
Platelet lyophilized treatment (PLT) is similar to PRP: it uses specialized laboratory techniques to freeze-dry platelets, controlling platelet count and bioactivity at an optimal ratio and concentration for clinical use. Compared to fresh PRP, PLT allows precise dosage monitoring, longer storage at room temperature, and standardized application.
Mechanisms of Action in Treating Erectile Dysfunction
The mechanism of PRP in treating erectile dysfunction (ED) relies primarily on platelets containing abundant growth factors and reparative cytokines capable of stimulating tissue regeneration and angiogenesis.
| Growth Factor | Mechanism of Action | Biological Effect |
|---|---|---|
| VEGF, SDF-1 | Angiogenesis | Stimulates new microvascular formation, improving cavernous blood supply |
| NGF, BDNF | Neuroregeneration | Promotes neural regeneration, supporting recovery in neurogenic erectile dysfunction |
| TGF-β, IL-10 | Anti-inflammation | Attenuates chronic inflammatory responses, mitigating tissue destruction and fibrosis |
| PDGF, EGF, IGF-1 | Tissue repair and Regeneration | Enhances smooth muscle cell activity, promoting matrix remodeling and structural recovery |
Treatment Procedure
During treatment, a fine needle is used to inject PRP into both sides of the corpora cavernosa; 1 to 4 injection points may be utilized depending on the clinical protocol and penile anatomy (Figure 1). Mild localized swelling, bruising, or transient discomfort may occur, which typically subsides within half a day. Patients can return home immediately following the procedure. It is advised to avoid sexual activity and vigorous physical exertion for 24 to 48 hours post-injection.
A typical treatment course comprises 3 to 6 sessions spaced 2 to 4 weeks apart, customized according to individual clinical status. A maintenance booster (boost therapy) may be considered every 6 to 12 months.
Contraindications
- Active local infection (penile skin infection)
- Systemic severe chronic infection or sepsis
- Severe hematologic disorders: thrombocytopenia, coagulation disorders (such as hemophilia), severe anemia, etc.
- Concurrent anticoagulant therapy
- Autoimmune conditions (e.g., systemic lupus erythematosus)
- Malignancy (especially urogenital malignancies)
- Uncontrolled chronic systemic diseases (diabetes, chronic liver disease, renal disease, severe cardiovascular disease, etc.)
Clinical Efficacy and Patient Satisfaction
PRP for erectile dysfunction remains an experimental regenerative therapy in contemporary medicine; therapeutic outcomes and patient satisfaction vary across clinical studies. Individual responses depend on age, etiology, and comorbid chronic conditions such as diabetes and hypertension. In clinical practice, the International Index of Erectile Function (IIEF) questionnaire and penile color Doppler ultrasonography are commonly utilized to assess erectile function and therapeutic progress.
Synthesizing available clinical literature to date, the overall improvement rate ranges between 40% and 70%, with patients reporting varied degrees of functional enhancement; benefits typically persist for approximately 6 months to 1 year, with some individuals benefiting from scheduled maintenance therapy. Regarding subjective satisfaction, approximately 60% to 80% report noticeable overall improvement and express willingness to undergo or recommend the procedure; however, 20% to 40% demonstrate limited measurable benefit. Patients with mild-to-moderate ED, vasculogenic ED (such as that secondary to hypertension or dyslipidemia), or those in early post-surgical nerve recovery phases tend to experience better responses; conversely, those with severe neurological damage, longstanding diabetes, or marked structural fibrosis generally experience poorer outcomes. Compared to oral pharmacotherapy, responses may not be as rapid or pronounced as PDE5 inhibitors (e.g., Viagra, Cialis); nevertheless, successful cases may allow some patients to reduce or discontinue medication.
Current clinical research remains in early stages, predominantly comprising smaller cohort trials, and requires confirmation through large-scale, long-term, randomized controlled trials. PRP demonstrates limited efficacy in severe end-stage organic ED (such as severe vascular insufficiency or dense denervation). Its primary advantage lies in utilizing autologous blood components, conferring minimal immunological rejection and low infection risks with high procedural safety; to date, no severe complications or major adverse events have been reported.
A 2024 meta-analysis indicated that platelet-rich plasma (PRP) exhibits favorable therapeutic efficacy in erectile dysfunction, particularly throughout a 6-month follow-up window. Compared with low-intensity extracorporeal shockwave therapy (Li-SWT) monotherapy, adding PRP significantly enhanced IIEF scores, though validation through larger clinical trials is essential. Furthermore, findings from the Phase II COCKTAIL clinical trial (NCT05048667) presented at the 2024 American Urological Association (AUA) Annual Meeting demonstrated that combining Li-SWT and PRP is safe; however, whether combination therapy confers definitive incremental clinical benefit remains unclear. Consequently, combined PRP and Li-SWT therapy remains an active subject of medical investigation.
Summary
Intracavernous PRP injection provides a non-pharmacologic, non-surgical treatment alternative. Overall, multiple studies indicate that PRP holds potential therapeutic benefit for primary organic erectile dysfunction stemming from vasculogenic, neurogenic, or mild diabetic factors. While most current trials are small in scale, PRP has demonstrated improvements in erectile firmness, sexual quality of life, and satisfaction in a subset of patients, accompanied by mild side effects primarily limited to transient injection-site discomfort. Nevertheless, further verification through extensive randomized controlled trials is warranted; concerning safety, no hemorrhagic incidents or significant adverse effects have been documented, and the synergy of combined Li-SWT and PRP remains under continuing evaluation.
Dr. Hsieh’s Clinical Insight:
PRP is not a universal cure; however, for patients with mild-to-moderate erectile dysfunction, suboptimal response to medication, or a desire to reduce pharmaceutical dependence through biological tissue repair, it represents a valid therapeutic option to explore. Prior to initiating PRP therapy, patients should consult directly with a urologist to thoroughly evaluate individual etiology, discuss expectations, and determine whether this modality is appropriate.
References
- 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.
- Poulios E, Daskalopoulou N, Kalyvianakis D, Tsounapi P, Saito M, Shimizu S, et al. Platelet-rich plasma improves erectile function through increased angiogenesis in a rat model of erectile dysfunction. J Sex Med. 2018;15(6):789–799.
- Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, et al. Erectile Dysfunction: AUA Guideline. J Urol. 2018;200(3):633–641.
- Zasieda SA, Louie KS, Tzeng CR, Hsieh TC. Emerging regenerative approaches for erectile dysfunction: Review of the literature. World J Mens Health. 2020;38(3):287–295.
- Wu YN, Wu CC, Sheu MT, Ho HO, Chen YC, Chiang HS. Platelet-rich plasma for the treatment of erectile dysfunction: A systematic review and meta-analysis. Andrology. 2021;9(4):1220–1228.
- Chung E, Wang J. Platelet-rich plasma (PRP) and platelet lysate (PL) in men’s sexual health: Fact or fiction? Int J Impot Res. 2021;33(6):620–627.
- Epifanova MV, Zakharenko EA, Gvozdev MY, Korneyev I. The efficacy of platelet-rich plasma in the treatment of erectile dysfunction: A systematic review and meta-analysis. Urologia. 2022;89(2):143–149.
- Asmundo MG, Durukan E, von Rohden E, Thy SA, Jensen CFS, Fode M. Platelet-rich plasma therapy in erectile dysfunction and Peyronie’s disease: a systematic review of the literature. World J Urol. 2024 May 29;42(1):359.
- Mao Q, Yang Y, Liu Y, Liu H, Tang G, Wang X, Cui Y, Wu J. The efficacy of platelet rich plasma in the treatment of erectile dysfunction: a systematic review and meta-analysis of randomized controlled trials. Aging Male. 2024 Dec;27(1):2358944.
- Clavijo RI, Kohn TP, Kohn JR, Ramasamy R. The efficacy of PRP alone or in combination with Li‑ESWT in treating erectile dysfunction: a systematic review and meta‑analysis of seven randomized controlled trials. Andrology. 2024;21(12):1152–1158.
- Ledesma BR, Molina M, Costantini‑Mesquita F, Petrella F, Saltzman R, Ramasamy R, Velasquez DA. Combined shockwave therapy and platelet-rich plasma (COCKTAIL) for erectile dysfunction – a Phase II trial emphasizing safety and efficacy. J Urol. 2024;èAbstract.