Tolerance and efficacy of platelet-rich plasma injections in Peyronie's disease: Pilot study

Platelet-rich plasma intra-plaque injections rapidly reduce penile curvature and improve sexual function in Peyronie's disease patients: results from a prospective large-cohort study

PURPOSE

To investigate efficacy and safety of platelet-rich plasma (PRP) intra-plaque injections in Peyronie's disease (PD) patients.

METHODS

Three injections of 6 mL PRP were performed two weeks apart. Patients were evaluated at baseline (T0, first injection), after two weeks (T1, second injection), and four weeks after the third injection (T2). The curvature angle of the erect penis, plaque size, dedicated sexual function questionnaires (PD questionnaire-PDQ, and International Index of Erectile Function five-items - IIEF-5) scores, and adverse events/side effects were evaluated.

RESULTS

Overall, 72 patients were included. Median age was 60 years, and median BMI was 23.1 kg/m2. Plaques were more frequently located at the middle third of the penis (n = 43); penile curvature direction was more frequently dorsal (n = 45). During follow up median plaque size decreased from 11.1 mm at T0 to 8.2 mm at T2 (p = 0.004), and median penile curvature decreased from 50.0° at T0 to 40.0° at T2 (p < 0.001). At the same timepoints, a statistically significant reduction was observed for all the three domains of the PDQ (PDQ1:p = 0.006, PDQ2:p = 0.002, PDQ3:p < 0.001), but not for the IIEF-5 (p = 0.3). At univariable linear regression analysis, testing the association between BMI and median penile curvature difference from the first and last evaluation, a tendency towards statistical significance was observed (β = -1.28, p = 0.055). No adverse events/side effect were registered.

CONCLUSION

PRP is a safe and effective treatment option in men with PD, rapidly reducing plaques size and penile curvature angle, thus positively influencing sexual function. The higher the BMI the lower benefit might be derived from PRP injection.

European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Hypogonadism, Erectile Dysfunction, Premature Ejaculation, and Peyronie's Disease

OBJECTIVE

The objective of this study is to present a summary of the updated 2025 European Association of Urology (EAU) guidelines on sexual and reproductive health (SRH), focusing on hypogonadism, erectile dysfunction (ED), premature ejaculation (PE), and Peyronie's disease (PD), providing practical recommendations on the clinical workup, with a focus on diagnosis, treatment, and follow-up.

EVIDENCE ACQUISITION

The panel conducted an updated systematic review of new research published in 2021-2024 in Medline, EMBASE, and Cochrane Libraries. The guidelines' recommendations focused on key clinical decisions that would impact patient care most. Each recommendation's strength was evaluated based on three factors: the trade-offs between benefits and drawbacks of different treatment approaches, the quality and reliability of the available evidence, and the diverse preferences and values of patients.

KEY FINDINGS

Along with a detailed basic and advanced diagnostic approach for every condition, key recommendations emphasise the importance of appropriate indications and subsequent follow-up for testosterone therapy in patients with late-onset hypogonadism (LOH), a clinical condition in the ageing male combining low levels of circulating testosterone and specific symptoms associated with impaired hormone production and/or action. The decision-making algorithm for treating ED-defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance-aims to support personalised treatment tailored to individual patients, according to the invasiveness, tolerability, and effectiveness of the different therapeutic options and patients' expectations. Hence, patients should be fully counselled with respect to all available treatment modalities. The EAU guidelines adopted the definition of PE, which has been developed by the International Society for Sexual Medicine. After the subtype of PE has been defined, patient's expectations should be discussed thoroughly, and pharmacotherapy must be considered as the first-line treatment for patients with lifelong PE, whereas treating the underlying cause must be the initial goal for patients with acquired PE. An accurate baseline assessment of patients with PD should differentiate between acute and stable phases of the disorder. Surgical treatment for PD should be offered to patients having a penile deformity with a negative impact on sexual function: patients with concomitant ED should be offered penile prosthesis implantation.

CONCLUSIONS AND CLINICAL IMPLICATIONS

This overview of the 2025 EAU SRH guidelines offers valuable insights into the diagnosis, treatment, and follow-up of LOH, ED, PE, and PD.

The role of platelet-rich plasma in biomedicine: A comprehensive overview

Biomedicine has seen significant advancements in the 21st century, with platelet-rich plasma (PRP) playing a crucial role in clinical practice. This blood derivative, enriched with platelet components, has shown great potential for promoting tissue repair and regeneration. Its wide range of applications and the presence of anti-inflammatory and growth-promoting factors make it a valuable tool in the field of biomedicine. The exploration of PRP in clinical settings has been gaining momentum. Despite its cost-effectiveness, safety, and therapeutic efficacy, the widespread clinical adoption of PRP has been hindered by the absence of consistent preparation standards and standardized treatment protocols. This article provides a comprehensive analysis of the clinical uses, physiological roles, molecular mechanisms, and preparation techniques of PRP in biomedicine. The aim is to offer a thorough understanding of the potential applications and benefits of PRP in medical practice.

French translation of the Peyronie's disease questionnaire: A pilot study

BACKGROUND

The Peyronie's Disease Questionnaire (PDQ) was designed to quantitatively assess the symptoms and psychosexual consequences of Peyronie's disease but has only been validated in four languages. The aim of the study was to provide a French translation of the PDQ, to make it available to the French-speaking urology community.

METHODS

After a double translation of the PDQ from English into French, followed by a back translation by four expert translators, a conciliation process enabled the creation of the final French version. For each item, participants were asked to answer two sub-questions. The percentage of responses "I fully understood the question" to sub-question (a) constituted the validation criterion for the translation.

RESULTS

The final French version was submitted to a series of 30 men with Peyronie's disease whose average age was 59 (±12) years. For each question, the comprehension rate was over 95%, and for 12/15 items it was 100%. For the remaining 3 items, men declared that they did not feel disturbed or bothered by the questions and none of the questions were misunderstood.

CONCLUSION

This pilot study shows that our translation of the PDQ is valid and comprehensible by all participants, regardless of the age or level of education. This French version should be validated further in other French-speaking populations before final validation.

LEVEL OF EVIDENCE: 2

A phase 2 randomized, placebo-controlled crossover trial to evaluate safety and efficacy of platelet-rich plasma injections for Peyronie's disease: clinical trial update

Peyronie's Disease (PD) is characterized by fibrotic plaques in the penile tunica albuginea, causing curvature and painful erections. Current treatments have limited established efficacy. Platelet-Rich Plasma (PRP), known for modulating inflammation, offers a potential alternative. This randomized, placebo-controlled, crossover study at the University of Miami assesses PRP's safety and efficacy for PD. Forty-one PD patients were randomized into PRP-placebo (Group A) and placebo-PRP (Group B) sequences, receiving two injections of each treatment over three months, with a crossover to receive two injections of alternate treatment over the next three months. Assessments include pain scale, goniometry, questionnaires, and curvature evaluations. Preliminary analysis of 28 patients shows that PRP is safe. There were no adverse events, including penile complications, during follow-up. Pain scores during treatments showed no significant difference between PRP and placebo (p = 0.52). Over six months, the PRP-Placebo group's median PDQ score decreased from 1.9 (IQR: 1.7-2.9) to 1.4 (IQR: 0.7-2.1). This change was not statistically significant (p = 0.098). In contrast, the Placebo-PRP group showed a significant reduction from 1.8 (IQR: 1.4-2.6) to 1.2 (IQR: 1.0-2.0) (p = 0.020). No significant changes in IIEF scores were observed. Both groups initially had a median penile curvature of 40 degrees. At 3 months, the PRP-Placebo group's curvature decreased to 38 degrees (IQR: 35-47.5), while the Placebo-PRP group decreased to 35 degrees (IQR: 30-60). At 6 months, the PRP-Placebo group showed a significant reduction to 25 degrees (IQR: 20-40, p = 0.047), while the Placebo-PRP group's reduction to 32.5 degrees (IQR: 20-50) was not significant (p = 0.490). These early results indicate a delayed PRP effect, prompting further investigation into its long-term impacts. Although limited by sample size, this study suggests PRP injections as a safe treatment for PD, with ongoing research aiming to clarify its therapeutic value.

Efficacy of platelet-rich plasma in the treatment of erectile dysfunction: A meta-analysis of controlled and single-arm trials

BACKGROUND

Erectile dysfunction (ED) is a prevalent condition in urology, and studies on the effectiveness of platelet-rich plasma (PRP) for this condition have been conducted; however, the evidence remains inconclusive. This meta-analysis aimed to evaluate the effectiveness of PRP in treating ED.

METHODS

On May 17, 2024, a literature search was performed and evaluated using the Cochrane method. The primary outcome measured was the International Index of Erectile Function (IIEF) score, while the secondary outcomes included Minimal Clinically Important Difference (MCID) and peak systolic velocity (PSV).

RESULTS

A total of 12 controlled trials involving 991 patients and 11 single-arm trials with 377 patients were analyzed. The findings revealed that compared to the control group, the PRP group demonstrated better outcomes in terms of the IIEF score and MCID (SMD = 0.59 (95% CI: [0.34, 0.84]; RR = 1.94 (95% CI: [1.33, 2.83]), In the single-arm trials, a significant improvement in IIEF scores was observed following PRP treatment (SMD = -0.99 95% CI: [-1.53, 0.46]).

CONCLUSION

PRP appears effective in treating erectile dysfunction, but further high-quality, large-sample trials with longer follow-up are needed to fully understand its effects.

Evidence of restorative therapies in the treatment of Peyronie disease: A narrative review

OBJECTIVE

To describe the evidence of Platelet Rich Plasma (PRP), Stem cells therapy (SCT) and Extracorporeal shockwave therapy (ESWL) for the treatment of Peyronies disease (PD), including information from the main urological society guidelines.

MATERIALS AND METHODS

A literature review of PubMed articles published between 2000 and 2023 was conducted, utilizing keywords such as "Peyronie's Disease", "Penile curvature", "Platelet Rich Plasma", "Stem cells", and "Extracorporeal shockwave therapy". Only full-text articles in English were included, excluding case reports and opinions.

RESULTS

A considerable number of clinical trials were conducted using PRP penile injections for therapy of PD, showing reduction of curvature, plaque size and improvement in quality of life. Preclinical studies in rats have shown the potential benefit of adipose-derived stem cells, with improvements in erectile function and fibrosis. Human studies with mesenchymal stem cells demonstrated promising results, with reduction of curvature and plaque size. ESWL effects on PD were investigated in randomized clinical trials and demonstrated no significant impact in curvature or plaque size, but reasonable effect on pain control.

CONCLUSION

Restorative therapies has emerged as an innovative treatment option for PD and the results from current studies appear to be promising and demonstrated good safety profile. Unfortunately, due to scarce evidence, PRP and SCT are still considered experimental by American Urological Association (AUA) and European Association of Urology (EAU) guidelines. ESWT is recommended, by the same guidelines, for pain control only. More high-quality studies with long-term follow-up outcomes are needed to evaluate efficacy and reproducibility of those therapies.

Skin Telocytes Could Fundament the Cellular Mechanisms of Wound Healing in Platelet-Rich Plasma Administration

For more than 40 years, autologous platelet concentrates have been used in clinical medicine. Since the first formula used, namely platelet-rich plasma (PRP), other platelet concentrates have been experimented with, including platelet-rich fibrin and concentrated growth factor. Platelet concentrates have three standard characteristics: they act as scaffolds, they serve as a source of growth factors and cytokines, and they contain live cells. PRP has become extensively used in regenerative medicine for the successful treatment of a variety of clinical (non-)dermatological conditions like alopecies, acne scars, skin burns, skin ulcers, muscle, cartilage, and bone repair, and as an adjuvant in post-surgery wound healing, with obvious benefits in terms of functionality and aesthetic recovery of affected tissues/organs. These indications were well documented, and a large amount of evidence has already been published supporting the efficacy of this method. The primordial principle behind minimally invasive PRP treatments is the usage of the patient's own platelets. The benefits of the autologous transplantation of thrombocytes are significant, representing a fast and economic method that requires only basic equipment and training, and it is biocompatible, thus being a low risk for the patient (infection and immunological reactions can be virtually disregarded). Usually, the structural benefits of applying PRP are attributed to fibroblasts only, as they are considered the most numerous cell population within the interstitium. However, this apparent simplistic explanation is still eluding those different types of interstitial cells (distinct from fibroblasts) that are residing within stromal tissue, e.g., telocytes (TCs). Moreover, dermal TCs have an already documented potential in angiogenesis (extra-cutaneous, but also within skin), and their implication in skin recovery in a few dermatological conditions was attested and described ultrastructurally and immunophenotypically. Interestingly, PRP biochemically consists of a series of growth factors, cytokines, and other molecules, to which TCs have also proven to have a positive expression. Thus, it is attractive to hypothesize and to document any tissular collaboration between cutaneous administered PRP and local dermal TCs in skin recovery/repair/regeneration. Therefore, TCs could be perceived as the missing link necessary to provide a solid explanation of the good results achieved by administering PRP in skin-repairing processes.

Acute Phase Peyronie's Disease: Where Do We Stand?

Peyronie's disease (PD) is a common benign condition characterized by superficial fibrosis and scar formation at the tunica albuginea of the penis, eventually leading to penile curvature. It is believed that penile micro-traumas during intercourse and subsequent activation of inflammatory processes constitute the pathogenetic basis of the disease. Routinely, PD is divided into acute and chronic phases, with pain during erection or flaccid state being the hallmark of the former. Surgical intervention should be avoided during the acute phase, as the risk of recurrence or progression of penile deformity during this stage might affect the optimal outcomes of the procedure. During this stage, many conservative treatment options have been suggested, including oral, topical, and intralesional therapies, extracorporeal shock wave therapy (ESWT), and penile traction therapy (PTT). Currently, the optimal treatment consists of a combined treatment strategy with phosphodiesterase type 5 inhibitors (PDE5Is), ESWT for pain management, PTT, and intralesional therapies. Large, well-designed randomized controlled trials (RCTs) are necessary to further elucidate the most efficient treatment option for acute phase PD.

Current trends in non-surgical management of Peyronie's disease-A narrative review

Peyronie's disease (PD) is a connective tissue disorder affecting the tunica albuginea. It can cause pain and penile deformation, and its prevalence increases with age. Although surgery is the gold standard for the chronic phase of the disease, there are several conservative treatment methods available, and the optimal management of the acute phase of the disease remains a matter of debate. In this article, we aim to summarize the recent trends in research on the subject of non-surgical treatment of PD. The search was performed in PubMed, Scopus, and Web of Science databases and included studies in English published between 2012 and 2022 investigating the clinical outcomes of non-surgical PD management in humans. We have identified 20 distinct conservative treatment strategies. Among the oral therapeutics, only the use of phosphodiesterase type 5 inhibitors is currently recommended for clinical use in patients with concomitant erectile dysfunction. The use of collagenase from Clostridium histolyticum is supported by the best quality evidence in terms of intralesional injections for patients suffering from significant penile curvature; however, interferon alpha-2b can also be an option in such patients. Among other non-invasive methods, extracorporeal shockwaves can be useful for pain reduction, and penile traction therapy can lead to a reduction in penile curvature and plaque size. Despite a wide range of non-surgical methods available for PD treatment, the majority are not supported by sufficient scientific evidence, and the treatment efficacy is underwhelming. Further research on the subject of non-surgical management of PD is highly warranted.

Identifying hub genes, key pathways and key immune-related genes in Peyronie's disease by integrated bioinformatic analysis

Scarring diseases, such as Peyronie's disease (PD), usually lead to disorders in the immune system. Previous studies suggested that the PD process was regulated by immune signaling. However, the pathogenetic mechanism remains incompletely characterized. This article used bioinformatic approaches to identify hub genes, key pathways and key immune-related genes that play essential roles in PD pathogenesis. Two Gene Expression Omnibus (GEO) datasets, GSE126005 and GSE146500, were used to analyse the transcriptional profiling in both PD and normal samples. R software was applied to examine the difference in the expression of hub genes and key immune-related genes. The candidates for hub genes were further validated through protein-protein interactions (PPIs), gene correlation, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. In addition, candidate miRNA‒mRNA pairs were functionally assessed. A total of 39 candidate genes were identified, the expression levels of which in PD fibroblast cells were different from those in normal cells (16 showed reduced expression in PD and 21 candidates overexpressed in PD). We found that these genes could interact with each other through PPI analysis. According to the functional enrichment analysis, the candidates may regulate some major biological processes, including cytokine‒cytokine receptor interactions and the JAK-STAT signaling pathway. IL6, IL21R, IFNE, CXCL2, EGF, and ANGPTL5 were identified as key immune-related genes. The findings may help understand the role of immunologic contributors in PD, thus shedding light on the development of more effective strategies to prevent and treat this kind of disease.