Regenerative and novel treatments for erectile dysfunction

Erectile dysfunction is a condition in which men find it difficult to achieve or maintain an erection for sexual intercourse. Many men struggle with this condition, often in silence, which can lead to depression and self-stigma. In this article, a consultant urological surgeon explores emerging and innovative treatments for erectile dysfunction: stem cell or platelet-rich plasma (PRP), Botox, and shockwave therapy.

An erection occurs through an increase in blood flow along the appendage to ‘inflate’ the tissues, most often during sexual arousal or stimulation. Erectile dysfunction is when this ability – the increase of blood flow – becomes impaired. Erectile dysfunction is rooted in vascular dysfunction of the penis, which in itself can have many causes, ranging from physical to psychological.

Physical, referring to biological or physiological, causes of erectile dysfunction include:

• Obesity
• Hypertension
• Diabetes
• Medicinal side effects
• Diseases of the nervous system, like multiple sclerosis, or nerve damage, such as from surgical complications
• Hormonal imbalance
• Sleeping problems
• Benign prostate enlargement
• Other factors that can reduce blood flow to the penis

Psychological causes of erectile dysfunction include:

• Stress and anxiety
• Depression
• Relationship issues

Erectile dysfunction is more likely to affect older men, drinkers, smokers, and drug users.

How is erectile dysfunction typically treated?

The treatment for erectile dysfunction varies according to the cause – patients with psychologically-based erectile dysfunction may benefit more from psychotherapy and counselling – but the baseline approach for physical erectile dysfunction is medication, typically oral phosphodiesterase type 5 (PDE5) inhibitors – such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) – which improve blood flow to the penis to enable lasting erections. If medication is ineffective, then other approaches are explored, such as:

• Penile injections
• Vacuum erection devices
• Surgical implants
• Hormone therapy

However, these treatments are either invasive or require repeated sessions over the years for satisfactory results.

New treatments for erectile dysfunction

The newest options for treating erectile dysfunction offer promising results with:

• Less invasive methods
• Quick, outpatient procedures
• Between one and five sessions
• Long-lasting improvement in penile function

The shared goal amongst them is increasing blood flow to the penis, which means they are not effective for erectile dysfunction caused by psychological or nervous system issues.

Platelet-rich plasma (PRP) therapy

PRP therapy is a regenerative treatment that utilises the patient’s own blood to repair damaged blood vessels, nerves, and muscles. Often used in sports medicine, this approach is now being studied for use in erectile dysfunction treatment.

PRP therapy works by isolating platelet-rich plasma from the blood, they are ‘boosted’ with platelets and growth factors to promote tissue regeneration. The process starts with the collection of a small volume of blood from the patient, which is then put into a centrifuge so that the plasma separates. This plasma contains platelets and growth factors in a concentrated form, which is then reinjected into the penis along several mapped-out spots in order to promote healing and regeneration.

The benefit of using the patient’s own blood is that there is a minuscule chance of a ‘bad’ reaction, though temporary bruising and swelling at the injection site are expected. Patients may need or request a local anaesthesia before the treatment is performed.

Patients who have undergone PRP therapy for their erectile dysfunction have reported that their erections have improved in longevity and frequency, and that they have more sensation in their penis, with the results lasting for at least a year, though results are not immediate. Because this treatment is just becoming available to the public, there is still a lot of research to be conducted and longer-term studies to evaluate the efficacy of this treatment are still underway.

Shockwave therapy

Shockwave therapy is a non-invasive, pain-free treatment that uses low-intensity acoustic soundwaves to target damaged or dysfunctional internal tissues of the penis. These shockwaves stimulate intra- and extracellular responses along the tissues of the penis, which improves blood flow, reduces inflammation, and also kickstarts the growth of new blood vessels (neovascularisation), thus facilitating easier and stronger erections.

Each session lasts 20 minutes, and most patients only need to undergo up to 12 sessions over a few months. Treatment is performed with a handheld probe that shoots out the shockwaves at target points on the penis. Patients will not need any anaesthetic for this procedure. This treatment works for most patients whose erectile dysfunction is rooted in vascular issues, and the results are maintained for more than half of patients for over a year.

Botox therapy

Botulinum toxin A – popularly referred to as Botox – is a neurotoxin that most people associate with aesthetic facial treatments, but actually has applications that can benefit the whole body. The purpose of Botox treatment for erectile dysfunction is to relax the smooth muscles along the penis, suppressing excess muscle activity, which allows easier blood circulation. It works by blocking a neurotransmitter called acetylcholine, which plays a role in contracting and stiffening muscles.

Much like PRP therapy, Botox is injected into several specific sites along the penis, and the patient may request or need an anaesthetic before the procedure. A session can last an hour, and treatment can be repeated a few times a year, although some patients find that the improvement after their first session is sufficient, with results evident within a few days, unlike stem cell therapy. Botox treatment is more suited to patients who want faster results, though this will not structurally improve blood flow within the penis through regeneration as PRP and shockwave therapy do.

The best way to treat erectile dysfunction will vary from patient to patient, but as these novel treatments are becoming more easily accessible, patients are left with many non-invasive, minimally-painful, and low-risk options to explore in order to regain their confidence and sexual function. Patients should discuss their options thoroughly with their urologists.