Stem-Cell, Shockwave, and Platelet Rich Plasma Therapy for the Treatment of Erectile Dysfunction and Peyronie's Disease: A Survey of Clinics Across the USA

Are patients undergoing intralesional collagenase Clostridium histolyticum injection therapy for Peyronie's disease compliant? A 7-year analysis from a tertiary care men's health center

BACKGROUND

Peyronie's disease (PD) involves the formation of fibrous scar tissue in the penis, causing pain, deformity, and significant psychological and sexual distress. Intralesional injection of collagenase Clostridium histolyticum (CCH) has emerged as a promising non-surgical treatment, though patients may experience complications and require multiple clinic visits.

AIM

This study aims to evaluate patient compliance with CCH therapy, compare outcomes between compliant and non-compliant groups, and identify reasons for non-compliance.

METHODS

This IRB-approved retrospective study analyzed patients with PD between 2017 and 2023. Patients were evaluated by a fellowship-trained andrologist. Patients who elected to have intralesional CCH were initially offered four cycles of treatment, with compliance defined as completing at least four cycles or achieving satisfactory results with fewer cycles.

OUTCOMES

Data on demographics, disease characteristics, treatment modalities, compliance, and outcomes were extracted from electronic medical records, and causes of non-compliance were identified. Outcomes and complications were compared between compliant and non-compliant groups.

RESULTS

Two hundred and ninety-two PD patients elected to have an intralesional injection of collagenase CCH. Among these, 51.4% completed four treatment cycles, 14.7% received more than four cycles, and 33.9% received fewer than four cycles. The overall compliance rate for injection therapy, including those satisfied with fewer cycles, was 70.89%. Mean pre-treatment curvature for 292 patients was 46.77 ± 14.26 degrees. Compliant patients showed a greater percent of curvature reduction (median 44.44 (IQR 34.17) vs 33.33 (IQR 44.17), P = .034) and less post-treatment curvature in degree (median 25.00 (IQR 17.02) vs 30.00 (IQR 23.75), P = .032) compared to non-compliant patients. Common reasons for incomplete treatment included adverse effects (15.1%), early satisfaction with results (14.1%), and unknown factors (45.4%).

CLINICAL IMPLICATIONS

Compliance with CCH therapy for PD significantly impacts treatment outcomes. Healthcare providers should address factors contributing to non-compliance. Qualitative studies are recommended to gain deeper insights into non-compliant patients.

STRENGTHS AND LIMITATIONS

This study analyzed compliance in a large cohort of PD patients and compared outcomes between compliant and non-compliant groups. However, missing data in the non-compliant group and the bias between compliant and non-compliant patients in this retrospective study are major notable limitations.

CONCLUSION

Overall compliance rate for CCH injection therapy was 70.89%. Greater curvature reduction was demonstrated in compliant patients. Common reasons for incomplete treatment included adverse effects (15.1%), early satisfaction with results (14.1%), and unknown factors (45.4%). However, missing data and bias from retrospective design are major limitations.

Treatment with Autologous Adipose-derived Regenerative Cells for Peyronie's Disease in Men: The Straight @head Pilot Study

Background and objective

We evaluated the effectiveness of injecting autologous adipose-derived regenerative cells (ADRCs) into plaque in men with chronic Peyronie's disease (PD).

Methods

This pilot safety study recruited 22 Danish men with chronic PD from an outpatient clinic. Patients received one bolus of ADRCs injected into plaque, with follow-ups at 1, 3, 6, and 12 mo. The primary endpoint was a reduction in penile curvature. Secondary endpoints were serious adverse events in relation to treatment, and patient-reported results for improvements, distress, and unhappiness related to PD.

Key findings and limitations

There was no significant difference in curvature after treatment. However, the participants reported subjective improvements, less distress, and a decrease in unhappiness. No severe adverse events were observed during 12-mo follow-up.

Conclusions and clinical implications

Injections of ADRCs into PD plaque appear to be safe but had no significant measurable effect on penile curvature. Half of the participants reported a subjective improvement.

Patient summary

We studied the safety and effectiveness of injections of patient-derived regenerative cells for chronic Peyronie's disease. While the curvature of the penis did not significantly improve, the treatment was safe and some men reported a decrease in their distress and an improvement in penile shape.

Rising public interest in stem cell therapy for erectile dysfunction: an analysis of public perception and a review of the literature

Purpose

The use of alternative treatment modalities for erectile dysfunction (ED) beyond phosphodiesterase inhibitors continues to grow within the practice of Urology. Utilizing U.S. Google trends as a novel epidemiological tool for geographically associating patient search intent, our study aims to capture trends relating to interest in stem cell therapy (SCT) as a potential treatment for ED.

Methods

An online search was conducted to identify centers in the United States offering stem cell therapy (SCT) for erectile dysfunction (ED), using specific keywords such as "ED treatment," "stem cells for ED," and "sexual health stem cell." The geographic distribution of these centers was mapped, and their publicly available information was evaluated based on strict inclusion criteria, including direct claims of SCT efficacy for ED and oversight by a licensed urologist. The public interest in SCT treatment was quantified using Google Trends data from July 2018 to July 2023, utilizing search terms related to SCT and comparing them to terms associated with alternative regenerative therapies like platelet-rich plasma and shockwave treatments, to extract the direction and magnitude of national interest over the preceding 5 years. The PubMed, Cochrane Library, and EMBASE databases were then searched from inception to May 2024 regarding evidence for the use of SCT to treat ED.

Results

Despite insufficient evidence, public search interest demonstrates an upward trajectory of this treatment when compared to alternative regenerative therapies for ED. This increased interest in SCT as a potential treatment option for ED may be linked to the marketing efforts of commercial entities. Throughout the qualitative analysis of advertisement sources, only two websites (Stem Cells Transplant Institute, and Ambrose Cell Therapy) summarized the collective results of a directed clinical trial investigating the utility of SCT in ED patients.

Conclusion

Our study demonstrates the public prevalence of patients seeking SCT as a treatment modality for ED is increasing. In addition, varied sources nationwide promote SCT despite limited scientific evidence and consensus. This disparity calls for additional prospective research on the viability, efficacy, and long-term safety of SCT in the context of ED.

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.

An update on the use of stem cell therapy for erectile dysfunction

Objective

This systematic review aimed to analyze animal and human trial data to better understand the efficacy of stem cell therapy (SCT) for erectile dysfunction (ED) and the obstacles that may hinder its application in this field.

Methods

We searched electronic databases, including PubMed and Scopus, for published studies with the Medical Subject Heading terms of "erectile dysfunction" (AND) "stem cell therapy" (OR) "erectile dysfunction" (AND) "clinical trial of stem cell therapy" (OR) "stem cell therapy" (AND) "sexual dysfunction". The search was limited to English-language journals and full papers only. The initial search resulted in 450 articles, of which 90 relevant to our aims were included in the analysis.

Results

ED is a multifactorial disease. Current treatment options rely on pharmacotherapy as well as surgical options. Patients may have side effects or unsatisfactory results following the use of these treatment options. SCT may restore pathophysiological changes leading to ED rather than treating the symptoms. It has been evaluated in animal models and shown promising results in humans. Results confirm that SCT does improve erectile function in animals with different types of SC use. In humans, evidence showed promising results, but the trials were heterogeneous and limited mainly by a lack of randomization and the small sample size. Many challenges could limit future research in this field, including ethical dilemmas, regulation, patient recruitment, the cost of therapy, and the lack of a standardized SCT regimen. Repairing and possibly replacing diseased cells, tissue, or organs and eventually retrieving normal function should always be the goals of any therapy, and this can only be guaranteed by SCT.

Conclusion

SCT is a potential and successful treatment for ED, particularly in patients who are resistant to the classic therapy. SCT may promote nerve regeneration and vascular cell regeneration, not only symptomatic treatment.

A primer on the restorative therapies for erectile dysfunction: a narrative review

INTRODUCTION

Erectile dysfunction (ED) is a common condition that affects millions worldwide. Patients and urologists alike are seeking alternative therapies that can provide long-lasting results in the treatment of ED. This review provides a comprehensive overview of restorative treatments available for ED, such as platelet-rich plasma, stem cell therapy, and shockwave therapy.

OBJECTIVE

The aim of this narrative review is to provide a primer for urologists and general practitioners on the basics of implementing ED restorative therapies in their practice.

METHODS

The PubMed, MEDLINE, and Google Scholar databases were searched for articles in the English language through August 31, 2023, that included key terms such as "erectile dysfunction," "restorative therapy," "shockwave therapy," "platelet-rich plasma," "stem cell therapy," and "stromal vascular fraction." Reference lists of selected studies were manually reviewed to find articles not identified by the initial database search.

RESULTS

Shockwave therapy has demonstrated effectiveness in treating ED, with devices like the Medispec ED1000 and Storz Duolith showing statistically significant improvements in patient scores for International Index of Erectile Function (IIEF)-Erectile Function scores in clinical trials. In reported studies of platelet-rich plasma injections, a substantial percentage of patients reached a minimal clinically important difference in the IIEF-Erectile Function scale after treatment. Studies of ED treatment with stem cell therapy, while limited and with small sample sizes, have demonstrated encouraging improvements in patient scores for the abridged 5-item version of the IIEF after treatment.

CONCLUSION

Shockwave, platelet-rich plasma, and stem cell therapies are important, novel, noninvasive restorative treatments for ED that can provide relief for patients wishing to avoid a more invasive approach. While these therapies have shown promising results in clinical trials, more research is required to establish them as standardized and efficacious options in the management of ED.

Search traffic for inflatable penile prosthesis increased following the COVID-19 pandemic in the United States: a Google Trends analysis

We aimed to determine the impact of the COVID-19 pandemic on search trends for inflatable penile implants in the US. Search trends for inflatable penile implants ranging from 2016 through 2023 were analyzed utilizing Google Trends. Associations between search trends and US Census Bureau data, including average household income and per capita income, were analyzed. Pre- and post- COVID-19, the interest in inflatable penile implants has been steadily increasing on average in the US. The average household income for counties with the highest interest in inflatable penile implants during the pre-COVID era was $53,136, whereas for the counties with the highest interest in inflatable penile implants in the post-COVID era, the average decreased to $50,940. Similarly, the average per capita median decreased from $35,209 to $34,547. Search traffic for inflatable penile prosthesis increased following the pandemic in the US. Nevertheless, post-pandemic, individuals with lower income levels showed no change in interest in penile implant searches compared to the pre-pandemic period. Understanding this steadiness in interest can inform healthcare professionals and policymakers to tailor interventions and educational efforts to reach a broader audience, ensuring equitable access to information and healthcare resources.