3rd Annual Jefferson Urology Symposium: Men’s Health Forum

© The Canadian Journal of Urology TM : International Supplement, August 2020 Platelet-rich plasma and other therapies Platelet-rich plasma (PRP) is an autologous blood product that contains a high amount of platelets with various growth factors, including platelet‐derived growth factor (PDGF), insulin‐like growth factor (IGF), fibroblast growth factor (FGF) and vascular endothelial growth factor (VEGF). These growth factors have been shown to induce angiogenesis, cell regeneration, proliferation, and differentiation with stemcell migration in preclinical and clinical studies. 49-53 Intracavernosal injection of PRP promotes nerve regeneration and the recovery of erectile function in rodent cavernous nerve injury models. 54-56 However, there has been a lack of understanding of the underlying mechanism of PRP on neuroregeneration in studies using animal models of cavernous nerve injury. 50,57,58 A phase 1 human trial of intracavernosal PRP in 17 patients with ED and Peyronie’s disease reported no major adverse effect. In the same study, ED symptoms were assessed in 7 men using IIEF-5 questionnaire, and IIEF scores were found to improve by an average of 4 pointswhile therewas no decline in erectile function. 50 However, PRP is considered an experimental treatment, and higher-quality randomized controlled studies with larger patient samples with long term follow up are needed. Conclusion In clinical practice, the majority of patients with ED are placed on oral treatment with PDE5i as initial therapy. However, improving overall health with lifestyle modificationand treatment of underlying comorbidities may alone enhance erectile function. The clinician should discuss all possible choices during the initial visit, regardless of its invasiveness, considering the patient’s health literacy and sociocultural background. Shared decision making between clinician, patient, and partner plays a vital role in promoting treatment Figure 1. Algorithm for the management principles of patient presenting with erectile disfunction. 33 The medical and surgical treatment of erectile dysfunction: a review and update