Regenerative therapies for erectile dysfunction: a systematic review, Bayesian network meta-analysis, and...

Area of Science:

• Urology
• Regenerative Medicine
• Men's Health

Background:

• Current erectile dysfunction (ED) guidelines emphasize shared decision-making.
• Regenerative therapies including stem cell therapy, platelet-rich plasma (PRP) injections, and low-intensity shockwave therapy (LIST) are gaining interest for ED.
• Comparative efficacy data for these regenerative ED treatments are limited.

Purpose of the Study:

• To systematically review and perform a network meta-analysis comparing stem cell therapy, PRP injections, and LIST for ED.
• To quantify the impact of these therapies on the International Index of Erectile Function (IIEF) score.

Main Methods:

• Systematic search of randomized clinical trials for stem cell therapy, PRP, and LIST in ED, published January 2024.
• Network meta-analysis using Review Manager 5.4 and R Studio, employing Markov Chain Monte Carlo sampling.
• Results expressed as standardized mean difference (SMD) with 95% credible intervals (CrI); meta-regression adjusted for PDE5 inhibitor use.

Main Results:

• Analysis of 16 studies with 907 patients.
• SMD (vs. control) for stem cell therapy: 0.92 [95% CrI -0.49, 2.3].
• SMD (vs. control) for PRP: 0.83 [95% CrI 0.15, 1.5].
• SMD (vs. control) for LIST: 0.84 [95% CrI 0.49, 1.2], with higher doses (0.15 mJ/mm²) showing greater effect (SMD 1.1 [95% CrI 0.36, 1.9]).
• Meta-regression for PDE5 inhibitor use was non-significant.

Conclusions:

• Stem cells, PRP, and LIST (especially at 0.15 and 0.09 mJ/mm²) may improve erectile function.
• LIST and PRP showed statistically significant improvements, but clinical relevance requires further evaluation.
• More research is needed to establish the efficacy of stem cell therapies for ED.