AUA 2023: State of the Art Lecture: Regenerative Medicine in Sexual Medicine: The Hard Facts

(UroToday.com) The 2023 American Urological Association (AUA) Meeting included a Sunday afternoon plenary session featuring a lecture on regenerative therapeutical options for sexual medicine. Dr. Yafi began his talk by going through erectile dysfunction therapies throughout time and the development of new therapies since 1998. He spoke about the definition of regenerative medicine, and that it means the replacement or regeneration of human cells, tissue, or organs to restore or establish normal function. Dr. Yafi proceeded to outline the four categories in regards to sexual medicine treatment they are: shockwave therapy (LiSWT), platelet rich plasma (PRP), stem cell therapy (SCT/SVF), and radiofrequency (RF).

He spoke about the different suggested mechanisms of action of shockwave therapy and the initial use of shockwave therapy for different fields, including cardiology and orthopedics. A study was referenced from Israel which studied shockwave therapy for erectile dysfunction and showed some promising results. He went on to differentiate between radial and focal shockwave therapy and pointed out that for creating a successful medical device, one must be careful which type of technology is used. In terms of low intensity shockwave therapy (LiSWT), this has been studied much more in-depth and randomized trials have shown a fair amount of benefit for patients with erectile dysfunction. Dr. Yafi remarked that there are limitations to shockwave therapy including the different machines available for use and different protocols for each machine. 

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Moving onto platelet-rich plasma (PRP), Dr. Yafi spoke on the common uses of the therapy and how it is created. There have only been two studies using PRP for erectile dysfunction, he noted. This therapy is currently being studied and it is unknown how much benefit it can provide quite yet. Problems with PRP therapy include no standardization to how the PRP is created and the treatment protocol is not yet defined. Additionally, there are a wide number of non-urologists which provide PRP.

Dr. Yafi spoke about stem cells and how there are embryonic, adult/mesenchymal, and stromal vascular fraction (SVF) subtypes. Data regarding SVF use is varied and there is no consensus on which type of stem cells to use. Dr. Yafi raised the point that stem cell therapy is expensive, ranging between $5,000 - $10,000 per treatment.

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Lastly, Dr. Yafi went on to highlight radiofrequency as a treatment for erectile dysfunction. He outlined two suggested mechanisms of action and introduced a self-applied device for radiofrequency that was developed in Israel. Studies have shown promising effect on treating erectile dysfunction, and future work is necessary.

He concluded that the placebo effect is real, and proven, in regards to treating men with erectile dysfunction and that this is important to keep in mind. Dr. Yafi ended his insightful presentation with noting that restorative therapies are gaining popularity, stem cells are on the horizon, focal shockwave therapies need to be studied further, and that the clinical efficacy of radiofrequency is unclear.

Presented by: Faysal Yafi, MD – Assistant Professor and Chief of Men’s Health and Reconstructive Urology, UC Irvine, Orange, CA

Written by: Allen Rojhani, BS; MD Candidate at the Drexel University College of Medicine and 2022-2023 LIFT Research Fellow at the University of California, Irvine Department of Urology during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023