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Regenerative Therapies for Erectile Dysfunction: A Systematic Review, Bayesian Network Meta-Analysis, and Meta-Regression - Beyond the Abstract

This systematic review and Bayesian network meta-analysis compares three emerging regenerative therapies—stem cell therapy (SCT), platelet-rich plasma (PRP), and low-intensity shockwave therapy (LiSWT)—for the treatment of erectile dysfunction (ED). Our findings showed that LiSWT and PRP therapies demonstrate statistically significant improvements in erectile function compared to controls. Among them, LiSWT appears particularly effective at specific energy densities, with dose-response effects observed. While these results are promising, the differences in control groups, follow-up durations, and variations in outcome measures across studies may impact the robustness of these findings, indicating a need for further research to clarify the long-term clinical relevance of these treatments.

The meta-regression analysis, particularly regarding PDE5 inhibitor use, shows non-significant results, suggesting that concomitant use of PDE5 inhibitors does not significantly modify the outcomes. However, as PDE5i administration frequency and dosages vary widely among patients, future studies could further explore how varying regimens might interact with these therapies. The results underscore LiSWT’s potential as a primary regenerative option for ED, with improvements observed at specific energy densities, particularly 0.15 mJ/mm². While statistically significant, the SMD improvements across treatments are difficult to translate into direct patient benefits without further clarification of their clinical meaning. Importantly, establishing MCID values for the specific IIEF variations used (e.g., IIEF-5 vs. full IIEF) would support a clearer assessment of the practical impact of these results. Clinicians may find it challenging to apply these findings without such metrics, as differences in scoring can influence treatment decision-making.

However, clinicians can leverage the insights from this paper to expand treatment options for patients with ED, particularly those who have not responded well to traditional therapies like PDE5 inhibitors. The findings suggest that regenerative therapies—especially LiSWT at optimal energy settings—can offer alternative or complementary benefits. By understanding the comparative efficacy of SCT, PRP, and LiSWT, clinicians can engage in informed discussions with patients about innovative therapies with regenerative potential, highlighting the importance of personalized treatment plans. Although more standardized, long-term studies are needed, this research provides a foundation for integrating regenerative therapies into shared decision-making processes, offering hope for sustainable improvements in erectile function and quality of life.

Written by: David E Hinojosa-Gonzalez,1 Gal Saffati,1 Daniela Orozco Rendon,1 Troy La,1 Shane Kronstedt,1 Akhil Muthigi,2 Mohit Khera,1

  1. Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.
  2. Department of Urology, Houston Methodist, Houston, TX, United States.

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