Jainik Shah et al., 2024: An overview of the Canadian landscape on the use of restorative therapies for erectile dysfunction and Peyronie's disease

Monday, 30 December 2024

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Jainik Shah 1, Maximilian G Fidel 1, Dhiraj S Bal 1, Armin Kharazi 2, Connor F Roque 1, Yool Ko 1, Karim Sidhom 3, David Bouhadana 4, Francis Petrella 4, Premal Patel 3
1Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
2Men's Health Clinic Manitoba, Winnipeg, MB, Canada.
3Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.
4Division of Urology, McGill University Health Center, Montreal, QC, Canada.

Abstract

Introduction: Restorative therapies (RTs), including low-intensity shockwave therapy (Li-SWT) and platelet-rich plasma (PRP), aim to restore natural erectile function. Many clinics offer these therapies for erectile dysfunction (ED) and Peyronie's disease (PD) with direct-to-consumer (DTC) marketing. This study sought to investigate the landscape of RTs within Canadian clinics.

Methods: Online searches were made to identify clinics offering Li-SWT and/or PRP as an RT for treating ED and PD in Canada. Public websites were analyzed, followed by calling clinics for data on cost, treatment protocols, clinic ownership, success rates, and adjunctive therapies.

Results: A total of 107 clinics were identified online, with a 68.2% call response rate (n=73). Of the respondents, 56 and 40 clinics provided Li-SWT and PRP therapies, respectively, with 23 clinics offering both. All clinics reported using RTs for ED, with 21 clinics offering Li-SWT and 22 clinics providing PRP for PD. Forty-three clinics provided costs and protocols for Li-SWT, while 33 clinics did so for PRP. The average cost ± standard deviation (CAD) of six sessions of Li-SWT was $2167.24±936.11 and one shot of PRP was $1478.68±591.98. Most (60.3%, n=44) clinics reported physician ownership, with a majority (n=28) being family medicine-trained. Seven clinics did not provide data and 22 were non-physician-owned. Ten clinics provided success rates, with an average of 87.3%.

Conclusions: Despite limited data supporting their routine clinical use, many clinics across Canada offer RTs for ED and PD with varying treatment protocols and increased costs. Further research is required to evaluate the efficacy of RT for ED and PD.

Can Urol Assoc J. 2024 Jul 15. doi: 10.5489/cuaj.8804. PMID: 39037510 FREE ARTICLE

Comments 1

Jens Rassweiler on Monday, 30 December 2024 10:00

ED and PD are prevalent men’s health issues, with ED affecting up to 50% of men over 40 and PD impacting over 7% of men globally. While established treatments exist, newer restorative therapies (RTs) like low-intensity extracorporeal shockwave therapy (Li-SWT) and platelet-rich plasma (PRP) injections are gaining popularity. These approaches aim to promote natural tissue regeneration but face mixed results regarding efficacy and concerns over inconsistent protocols and unregulated marketing. This study analyzes the actual situation on Canada.

Study Design: A cross-sectional study analyzed clinics offering Li-SWT and PRP for ED and PD across Canada. Public data was collected from clinic websites and supplemented by direct inquiries. Data included treatment costs, protocols, ownership, and provider qualifications.

Results:
Clinic Landscape: 107 clinics were initially identified; 73 provided complete data.:
- 76.7% offered Li-SWT.
- 54.8% offered PRP.
- 31.5% offered both for ED and PD.
Costs: There was a wide range of costs:
- Average cost for six Li-SWT sessions: $2,167.24 CAD (range: $700–$4,000).
- Average cost for one PRP session: $1,478.68 CAD (range: $466–$3,000).
Only 13.1% of clinics listed costs upfront, and fewer reported success rates.
Provider Training: Only 9.6% had a urologist on staff and 39.8% lacked involvement of a medical doctor.
Challenges: There is mixed evidence, with limited randomized controlled trials (RCTs) and a lack of standardized protocols and quality control. Direct-to-consumer (DTC) promotion risks misleading patients, exacerbating financial and psychosocial burdens. Based on this some
professional bodies like the Canadian Urological Association (CUA), American Urological Association (AUA) currently advise against routine clinical use of Li-SWT and PRP, citing insufficient evidence. EAU-Guidelines recommend Li-ESWT for vasculogenic ED.

Conclusions:
RTs for ED and PD are growing in availability but are hindered by unclear efficacy and high costs. More rigorous studies are needed to evaluate their true benefits, refine treatment protocols, and address predatory marketing practices. Patient education and informed consent are crucial to mitigating risks and ensuring ethical use of these therapies.
In summary, this study shows the actual practice in Canada. Some issues are really striking, such as the high variability of costs and the low impact of urologists performing the treatment.

Jens Rassweiler

Study Design: A cross-sectional study analyzed clinics offering Li-SWT and PRP for ED and PD across Canada. Public data was collected from clinic websites and supplemented by direct inquiries. Data included treatment costs, protocols, ownership, and provider qualifications.

Results:
Clinic Landscape: 107 clinics were initially identified; 73 provided complete data.:
-	76.7% offered Li-SWT.
-	54.8% offered PRP.
-	31.5% offered both for ED and PD.
Costs: There was a wide range of costs:
-	Average cost for six Li-SWT sessions: $2,167.24 CAD (range: $700–$4,000).
-	Average cost for one PRP session: $1,478.68 CAD (range: $466–$3,000).
Only 13.1% of clinics listed costs upfront, and fewer reported success rates.
Provider Training: Only 9.6% had a urologist on staff and 39.8% lacked involvement of a medical doctor.
Challenges: There is mixed evidence, with limited randomized controlled trials (RCTs) and a lack of standardized protocols and quality control. Direct-to-consumer (DTC) promotion risks misleading patients, exacerbating financial and psychosocial burdens. Based on this some
professional bodies like the Canadian Urological Association (CUA), American Urological Association (AUA) currently advise against routine clinical use of Li-SWT and PRP, citing insufficient evidence. EAU-Guidelines recommend Li-ESWT for vasculogenic ED.

Conclusions:
RTs for ED and PD are growing in availability but are hindered by unclear efficacy and high costs. More rigorous studies are needed to evaluate their true benefits, refine treatment protocols, and address predatory marketing practices. Patient education and informed consent are crucial to mitigating risks and ensuring ethical use of these therapies.
In summary, this study shows the actual practice in Canada. Some issues are really striking, such as the high variability of costs and the low impact of urologists performing the treatment.

Jens Rassweiler

ED and PD are prevalent men’s health issues, with ED affecting up to 50% of men over 40 and PD impacting over 7% of men globally. While established treatments exist, newer restorative therapies (RTs) like low-intensity extracorporeal shockwave therapy (Li-SWT) and platelet-rich plasma (PRP) injections are gaining popularity. These approaches aim to promote natural tissue regeneration but face mixed results regarding efficacy and concerns over inconsistent protocols and unregulated marketing. This study analyzes the actual situation on Canada. Study Design: A cross-sectional study analyzed clinics offering Li-SWT and PRP for ED and PD across Canada. Public data was collected from clinic websites and supplemented by direct inquiries. Data included treatment costs, protocols, ownership, and provider qualifications. Results: Clinic Landscape: 107 clinics were initially identified; 73 provided complete data.: - 76.7% offered Li-SWT. - 54.8% offered PRP. - 31.5% offered both for ED and PD. Costs: There was a wide range of costs: - Average cost for six Li-SWT sessions: $2,167.24 CAD (range: $700–$4,000). - Average cost for one PRP session: $1,478.68 CAD (range: $466–$3,000). Only 13.1% of clinics listed costs upfront, and fewer reported success rates. Provider Training: Only 9.6% had a urologist on staff and 39.8% lacked involvement of a medical doctor. Challenges: There is mixed evidence, with limited randomized controlled trials (RCTs) and a lack of standardized protocols and quality control. Direct-to-consumer (DTC) promotion risks misleading patients, exacerbating financial and psychosocial burdens. Based on this some professional bodies like the Canadian Urological Association (CUA), American Urological Association (AUA) currently advise against routine clinical use of Li-SWT and PRP, citing insufficient evidence. EAU-Guidelines recommend Li-ESWT for vasculogenic ED. Conclusions: RTs for ED and PD are growing in availability but are hindered by unclear efficacy and high costs. More rigorous studies are needed to evaluate their true benefits, refine treatment protocols, and address predatory marketing practices. Patient education and informed consent are crucial to mitigating risks and ensuring ethical use of these therapies. In summary, this study shows the actual practice in Canada. Some issues are really striking, such as the high variability of costs and the low impact of urologists performing the treatment. Jens Rassweiler

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