Zhou Z. et al., 2025: The efficacy of platelet-rich plasma (PRP) alone or in combination with low intensity shock wave therapy (Li-SWT) in treating erectile dysfunction: a systematic review and meta-analysis of seven randomized controlled trials.

Thursday, 26 June 2025

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Zhongbao Zhou 1, Yongqiang Wang 2, Yumeng Chai 1, Tao Wang 1, Pu Yan 1, Yong Zhang 1, Xudong Yang 1
1Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
2Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.

Abstract

Background: The goal of this meta-analysis intended to identify the efficacy of platelet-rich plasma (PRP) alone or in combination with low intensity shock wave therapy (Li-SWT) as a therapy for erectile dysfunction (ED).

Methods: This study integrated and analyzed the data using Cochrane method and GRADEpro GDT grading system. The registration number for this study was CRD42024618240.

Result: Seven randomized controlled trials with 660 patients were analyzed. The results indicated that compared with the control group, IIEF score of patients in the PRP group improved significantly at 12-week (p = 0.03) and 24-week (p = 0.0004), while there was no significant difference at 4-week. The PRP group had no significant advantages over the control group in terms of MCID and SEP Q3. For peak systolic velocity, patients in the PRP group demonstrated greater improvement than those in the control group (p < 0.00001). Subgroup analysis revealed that adding PRP regimen can considerably improve IIEF scores of ED patients compared to using Li-SWT alone (p < 0.0001).

Conclusion: PRP demonstrated a better efficacy in treating ED, especially during a follow-up period of 6 months. Compared with using Li-SWT alone, the addition of PRP can considerably improve the IIEF score of ED patients. These findings still required large-scale clinical trials for verification.

Aging Male. 2025 Dec;28(1):2472786. doi: 10.1080/13685538.2025.2472786. Epub 2025 Mar 4. PMID: 40037837

Comments 1

Jens Rassweiler on Thursday, 26 June 2025 11:00

Background: Erectile dysfunction (ED) is a prevalent disorder affecting men's ability to achieve or maintain an erection. Traditional therapeutic options, such as phosphodiesterase 5 inhibitors (PDE5I), hormone therapy, and intracavernosal injections, often fail to reverse underlying causes, leading to interest in alternative treatment methods. PRP, containing high concentrations of platelets and growth factors, shows promise in regenerating tissues due to its role in angiogenesis and cell repair. Li-SWT is also noted for its potential in stimulating tissue regeneration.

Objectives:This systematic review and meta-analysis aimed to assess the efficacy of PRP therapy, both alone and combined with Li-SWT, in treating ED, utilizing only randomized controlled trials (RCTs).

Methods:The analysis included seven RCTs with 660 participants from various countries. The inclusion criteria focused on studies that analyzed PRP interventions for ED. The studies were evaluated for quality, and various outcomes, including the International Index of Erectile Function (IIEF) scores, were measured at 4, 12, and 24-week follow-ups.

Results: The following results were found in the literature
IIEF Scores:
- At 4 weeks, there was no significant difference in IIEF scores between the PRP and control groups.
- By 12 weeks, the PRP group showed significant improvement compared to controls (MD 1.97, p=0.03).
- At 24 weeks, improvements were even more pronounced (MD 2.46, p=0.0004).

SEP Q3 and MCID: No significant benefits were recorded for these outcomes between PRP and control groups.

Peak Systolic Velocity: PRP therapy resulted in significant improvements in peak systolic velocity compared to controls at all time points.
Subgroup Analysis: Combining PRP with Li-SWT significantly improved IIEF scores compared to Li-SWT alone.

Quality of Evidence:The strength of the overall evidence was classified as low to moderate due to the limited number of RCTs and the variability in intervention standards.

Discussion:While traditional therapies have limitations, PRP shows promise in promoting erectile function, particularly when combined with Li-SWT. The study discusses the biological mechanisms of PRP, including its ability to enhance endothelial function, which plays a critical role in achieving and maintaining erections. However, the potential of PRP treatment is limited by factors such as small sample sizes and the lack of standardization in treatment protocols.

Conclusions: PRP represents a promising treatment option for ED, especially when used in conjunction with Li-SWT. However, further large-scale clinical trials are necessary to establish its efficacy definitively and to develop standardized treatment protocols. It is also important to evaluate such patients over a longer period of time, since all these biological effects need time.

This article provides insights into innovative approaches to ED treatment, emphasizing the need for ongoing research in regenerative therapies.

Jens Rassweiler

Objectives:This systematic review and meta-analysis aimed to assess the efficacy of PRP therapy, both alone and combined with Li-SWT, in treating ED, utilizing only randomized controlled trials (RCTs).

Methods:The analysis included seven RCTs with 660 participants from various countries. The inclusion criteria focused on studies that analyzed PRP interventions for ED. The studies were evaluated for quality, and various outcomes, including the International Index of Erectile Function (IIEF) scores, were measured at 4, 12, and 24-week follow-ups.

Results: The following results were found in the literature
IIEF Scores:
  - At 4 weeks, there was no significant difference in IIEF scores between the PRP and control groups. 
  - By 12 weeks, the PRP group showed significant improvement compared to controls (MD 1.97, p=0.03).
  - At 24 weeks, improvements were even more pronounced (MD 2.46, p=0.0004).

SEP Q3 and MCID: No significant benefits were recorded for these outcomes between PRP and control groups.

Peak Systolic Velocity: PRP therapy resulted in significant improvements in peak systolic velocity compared to controls at all time points.
Subgroup Analysis: Combining PRP with Li-SWT significantly improved IIEF scores compared to Li-SWT alone.

Quality of Evidence:The strength of the overall evidence was classified as low to moderate due to the limited number of RCTs and the variability in intervention standards.

Discussion:While traditional therapies have limitations, PRP shows promise in promoting erectile function, particularly when combined with Li-SWT. The study discusses the biological mechanisms of PRP, including its ability to enhance endothelial function, which plays a critical role in achieving and maintaining erections. However, the potential of PRP treatment is limited by factors such as small sample sizes and the lack of standardization in treatment protocols.

Conclusions: PRP represents a promising treatment option for ED, especially when used in conjunction with Li-SWT. However, further large-scale clinical trials are necessary to establish its efficacy definitively and to develop standardized treatment protocols. It is also important to evaluate such patients over a longer period of time, since all these biological effects need time.

This article provides insights into innovative approaches to ED treatment, emphasizing the need for ongoing research in regenerative therapies.

Jens Rassweiler

Background: Erectile dysfunction (ED) is a prevalent disorder affecting men's ability to achieve or maintain an erection. Traditional therapeutic options, such as phosphodiesterase 5 inhibitors (PDE5I), hormone therapy, and intracavernosal injections, often fail to reverse underlying causes, leading to interest in alternative treatment methods. PRP, containing high concentrations of platelets and growth factors, shows promise in regenerating tissues due to its role in angiogenesis and cell repair. Li-SWT is also noted for its potential in stimulating tissue regeneration. Objectives:This systematic review and meta-analysis aimed to assess the efficacy of PRP therapy, both alone and combined with Li-SWT, in treating ED, utilizing only randomized controlled trials (RCTs). Methods:The analysis included seven RCTs with 660 participants from various countries. The inclusion criteria focused on studies that analyzed PRP interventions for ED. The studies were evaluated for quality, and various outcomes, including the International Index of Erectile Function (IIEF) scores, were measured at 4, 12, and 24-week follow-ups. Results: The following results were found in the literature IIEF Scores: - At 4 weeks, there was no significant difference in IIEF scores between the PRP and control groups. - By 12 weeks, the PRP group showed significant improvement compared to controls (MD 1.97, p=0.03). - At 24 weeks, improvements were even more pronounced (MD 2.46, p=0.0004). SEP Q3 and MCID: No significant benefits were recorded for these outcomes between PRP and control groups. Peak Systolic Velocity: PRP therapy resulted in significant improvements in peak systolic velocity compared to controls at all time points. Subgroup Analysis: Combining PRP with Li-SWT significantly improved IIEF scores compared to Li-SWT alone. Quality of Evidence:The strength of the overall evidence was classified as low to moderate due to the limited number of RCTs and the variability in intervention standards. Discussion:While traditional therapies have limitations, PRP shows promise in promoting erectile function, particularly when combined with Li-SWT. The study discusses the biological mechanisms of PRP, including its ability to enhance endothelial function, which plays a critical role in achieving and maintaining erections. However, the potential of PRP treatment is limited by factors such as small sample sizes and the lack of standardization in treatment protocols. Conclusions: PRP represents a promising treatment option for ED, especially when used in conjunction with Li-SWT. However, further large-scale clinical trials are necessary to establish its efficacy definitively and to develop standardized treatment protocols. It is also important to evaluate such patients over a longer period of time, since all these biological effects need time. This article provides insights into innovative approaches to ED treatment, emphasizing the need for ongoing research in regenerative therapies. Jens Rassweiler

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