The Role of Different Modalities of Regenerative Therapies in the Treatment of Erectile Dysfunction: A Global Survey and Global Andrology Forum Expert Recommendations.

Abstract

Purpose: There is increased interest in regenerative therapies (RTs) to treat erectile dysfunction (ED). However, the need for society's guidelines has led to varied practices. This study aims to investigate current global practices, address the heterogeneity in treatment protocols and evaluations, and establish expert recommendations in clinical practice.

Materials and methods: Senior experts from the Global Andrology Forum (GAF) created a 32-question survey to evaluate the clinical aspects of various RT modalities and compare them with each other and with phosphodiesterase type 5 inhibitors (PDE5is). The survey was distributed worldwide to ED specialists through online Google Forms, the GAF website, international professional societies, and direct emails. The responses were analyzed and are presented as percentage frequencies. Additionally, an expert consensus on recommendations for RT use was reached at via a modified Delphi method.

Results: Out of 163 respondents from 39 countries, the majority (80.1%) were using low-intensity shockwave therapy (LISWT), followed by platelet-rich plasma (PRP) 61.3% and stem cell therapy (SCT) 17.8%. Efficacy comparisons revealed no perceived significant differences among RT modalities (p=0.124). Compared to PDE5is, the efficacy of LISWT and PRP was considered lower by the respondents, while SCT was rated better by almost half of those who used SCT. The duration of improvement varied (p=0.279), with most improvements lasting 1 to 6 months. The treatment protocols used for LISWT were mainly consistent but varied widely for PRP and SCT. Adverse effects were minimal, particularly for LISWT (p<0.001). The costs varied significantly (p<0.001), with SCT being the most expensive. The evidence for efficacy was rated as primarily moderate to strong for LISWT but poor for PRP and SCT (p=0.027).

Conclusions: Most respondents utilized LISWT, followed by PRP, with SCT being the least commonly utilized. The high break heterogeneity in treatment protocols and evaluation of RT underscores the need for further studies and guidelines to establish best practices.