Dogan K. et al., 2025: Erectile Function Recovery Using Shockwave and Platelet-Rich Plasma: A Single-Centre Prospective Comparative Study.
Kazim Dogan 1, Gökhan Cil 2
1Department of Urology, Faculty of Medicine, Istinye University, 34010 Istanbul, Turkey.
2Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, 34200 Istanbul, Turkey.
Abstract
Background: The study aimed to analyse the comparative effect of low-intensity extracorporeal shockwave therapy (Li-ESWT), platelet-rich plasma (PRP), and their combination for treating arteriogenic erectile dysfunction (ED).
Methods: This prospective observational study involved men diagnosed with arteriogenic ED over six months. Four hundred men aged 35-65 with ED, diagnosed using the International Index of Erectile Function (IIEF-5) and penile colour Doppler ultrasonography (USG), joined the research. The participants were divided into four groups: Li-ESWT, PRP, Li-ESWT + PRP, and Control. Outcomes were assessed at baseline and at one, three and six months post-treatment, focusing on changes in IIEF-5 scores and penile haemodynamics, including peak systolic velocity (PSV) and end-diastolic velocity (EDV).
Results: Li-ESWT significantly improved IIEF-5 scores from baseline to three months (p = 0.001), with sustained but reduced effects at six months (p = 0.001). PRP alone showed mild improvement at one month (p = 0.028), with no significant effect persisting at six months (p = 0.119). Combination therapy demonstrated the most pronounced and sustained improvement in IIEF-5 scores, particularly at three and six months (p = 0.001). Haemodynamic analysis revealed a significant increase in PSV at three months in the Li-ESWT and combination groups (p = 0.001) with mild regression at six months (p = 0.003). EDV changes were negligible across all groups and time points (p > 0.05).
Conclusions: Combining Li-ESWT and PRP provided the most substantial and sustained improvement in erectile function and arterial haemodynamics. While Li-ESWT demonstrated notable efficacy, PRP alone showed limited and transient benefits.
Arch Esp Urol. 2025 Sep;78(8):1029-1036. doi: 10.56434/j.arch.esp.urol.20257808.135. PMID: 41111374 FREE ARTICLE
Comments 1
The article presents a single-center prospective comparative study that investigates the effectiveness of low-intensity extracorporeal shockwave therapy (Li-ESWT), platelet-rich plasma (PRP) therapy, and their combination in treating arteriogenic erectile dysfunction (ED). Erectile dysfunction (ED) is a condition characterized by the inability to achieve or maintain an erection sufficient for sexual activity. Its causes are multifaceted, with vasculogenic factors being the most common. The International Index of Erectile Function (IIEF) serves as a diagnostic tool for assessing the severity of ED. Li-ESWT is believed to improve ED by enhancing blood flow and promoting tissue regeneration, while PRP therapy utilizes growth factors from the patient's own blood to stimulate tissue repair.
Study Design
The study involved 400 male patients aged 35-65, diagnosed with arteriogenic ED based on IIEF-5 scores and penile Doppler ultrasonography. Patients were divided into four groups: Li-ESWT (using St, PRP, Li-ESWT + PRP, and a control group with no active treatment. Primary outcomes measured were changes in IIEF-5 scores, while secondary outcomes included penile hemodynamic parameters such as peak systolic velocity (PSV) and end-diastolic velocity (EDV).
Treatment Protocol
The authors used an electromagnetic shockwave in the Li-ESWT (Duolith-Storz, Switzerland). Each treatment session involved the administration of 2400 shockwave pulses to the penile shaft and crura (frequency: 3 Hz and density of 0.12 mJ/mm2), with two sessions a week for a total of six applications. Shockwaves were administered to the distal, middle and proximal shafts, as well as the crura of the penis.
In the PRP group, patients underwent a procedure where 30 mL of blood was drawn and centrifuged at 3700 × g for 10 minutes to isolate PRP, which was injected into the penile corpus cavernosum at four sites.
Results
Erectile Function: All treatment groups showed improvements in IIEF-5 scores over time. The combination of Li-ESWT + PRP resulted in the most significant improvement, especially at the third month post-treatment. Li-ESWT alone also showed considerable improvement, while PRP alone had a modest and temporary effect.
Penile Vascular Outcomes: Li-ESWT significantly improved PSV, indicating better arterial blood flow, while PRP did not show significant changes in PSV. Neither treatment significantly affected EDV, suggesting limited effects on venous dynamics.
Adverse Events:** Minor adverse effects such as pain and hematoma after injection of PRP were reported, but no serious complication occured.
Discussion
This study contributes valuable insights into the management of arteriogenic ED, a condition that significantly impacts quality of life. The findings support the use of Li-ESWT as a promising treatment modality, particularly due to its ability to enhance blood flow and tissue regeneration. The combination of Li-ESWT and PRP therapy appears to yield synergistic benefits, which could represent a new standard in ED treatment.
The use of objective measures such as PSV alongside the subjective IIEF-5 scores strengthens the validity of the outcomes. However, the limitations noted, including the relatively short follow-up period and the single-center design, suggest caution in generalizing these findings. Future studies with larger cohorts and diverse patient demographics will be essential to confirm these results and further elucidate the mechanisms underlying the effectiveness of these therapies.
Overall, the research underscores the importance of a multifaceted approach to treating ED, recognizing the interplay between vascular health, tissue regeneration, and psychological factors. Continued exploration in this area may lead to more effective and personalized treatment strategies for patients suffering from this condition.
Conclusions
The study concluded that both Li-ESWT and PRP can effectively improve erectile function, with the combination showing the most promise. However, the effects of Li-ESWT were more pronounced than those of PRP alone. Thus, in most cases monotherapy with Li-ESWT might be sufficient.
Importantly, the study highlights the need for further research with longer follow-up durations to assess the sustainability of treatment effects and the long-term safety profile of these therapies.
Jens Rassweiler