Shockwave versus Platelet Rich Plasma for Erectile Dysfunction
Erectile dysfunction is an increasingly prevalent condition that affects a significant proportion of men worldwide. With increasing aging population, and the rise of risk factors such as diabetes and hypertension, this condition is found in all countries and unfortunately in lower age groups, younger than seen in the past.
The prevalence of ED increases with age. Many studies have shown that approximately 52% of men between the ages of 40 and 70 have some degree of ED. The incidence rises with age with around 40% of men aged 40-49 years affected compared to 70% of men aged 70-79 years. Lifestyle factors such as smoking, alcohol use, poor diet, obesity, lack of exercise significantly contribute to the development of ED with numbers increasing daily.
Erectile dysfunction is defined as the inability to achieve or maintain an erection sufficient for sexual activity. ED can be primary where a man has never been able to achieve an erection or secondary where ED was not present initially but developed later in life. Secondary is the most common subgroup.
Traditional Treatment Protocols for Erectile Dysfunction
Pharmacological Treatments
The first line treatments for ED are typically oral phosphodiesterase type 5 inhibitors which include sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Stendra). These medicines all work by increasing blood flow to the penis by inhibiting the PDE5 enzyme which degrades cyclic GMP, a molecule which facilitates vasodilation. These drugs differ in the duration of action and onset.
A. Sildenafil, Viagra- Effective for 4-5 hours and should be taken 30-60 minutes before sexual activity.
B. Tadalafil, Cialis- Long acting up to 36 hours.
C. Vardenafil, Levitra- Similar to Viagra in effectives and duration.
D. Avanadil, Stendra- Newest PDE5 inhibitor with faster onset of action.
Although these drugs are the first line treatment for erectile dysfunction, they are not without side effects. These include headaches, facial flushing, visual disturbances, nasal congestion and in rare case priapism which is prolonged erections which are considered a medical emergency.
Tachyphylaxis is a phenomenon where repeated use of these drugs causes reduced effectiveness over time. Higher doses are needed until these drugs no longer are effective.
Injectable Therapy and Urethral Suppositories
Intracavernosal injections using a vasodilator such as alprostadil or a combination therapy with phentolamine and papaverine can be used when oral drugs fail. These medications relax the smooth muscle of the vasculature inducing an erection by increasing the blood flow.
The suppositories work in the same manner and are effective but cause urethral pain, fibrosis and priapism.
Vacuum Erection Devices
These work by creating a negative pressure around the penis which causes increased blood flow. Side effects such as bruising, pain and nerve damage are common with prolonged use.
Surgical Options
Surgery is considered the final treatment modality for ED. A penile implant is inserted and can be pumped up when an erection is desired. However, as a surgical procedure, there are risks of infection and failures of these devices.
Penile revascularization surgery is an option for patients with arterial insufficiency, but studies demonstrate limited success rates.
Emerging Regenerative Therapies for ED: PRP vs Shockwave
Platelet Rich Plasma and Extracorporeal Shock Wave Therapy have emerged as newer treatments for ED with excellent success rates. Which one is better?
How Shockwave Therapy Works for Erectile Dysfunction
Extracorporeal Shock Wave Therapy works by applying acoustic waves of energy to the penis. This induces a biological response that promotes tissue regeneration and enhances blood flow to the penis. The primary mechanism is the stimulation of angiogenesis which is the formation of new blood vessels through the release of growth factors such as vascular endothelial growth factor.
Additionally, shock waves improve endothelial function which increase the release of nitric oxide, a critical component in erectile function.
Shock waves also trigger the release of cytokines which enhance tissue repair and neovascularization. Further actions include the stimulation of extracellular matrix proteins improving function. Finally, shock waves can remove blockages in the vasculature promoting increased blood flow to the tissues and enhancing the overall formation of erections.
Numerous studies have evaluated the efficacy of shockwave therapy in treating erectile dysfunction with promising results. It was proven shockwaves improve erectile dysfunction significantly in men with moderate ED. The treatment is most effective for ED in patients caused by vascular origin by improving blood flow.
Typical treatments can provide a duration of improvement lasting up to a year when 12 sessions were provided.
Shock wave therapy is considered safe with minimal side effects. The most common side effect is mild discomfort during treatment, redness or bruising at the treated site. Serious side effects such as penile injury, scarring or fibrosis are rare.
In rat models, penile shockwave therapy induced angiogenesis and regeneration of the neuronal nitric oxide synthase positive nerves, endothelium and smooth muscle cells. Shockwave has been suggested by the European Association of Urology guideline for individuals who had a poor response to PDE5 drugs.
How Platelet Rich Plasma Improves Erectile Function
Platelet Rich Plasma is an autologous blood derived concentrate that is rich in cytokines, growth factors and bioactive proteins. It has been extensively studied and has been proven to be advantageous in multiple regenerative treatments.
Platelet Rich Plasma contains several growth factors such as platelet derived growth factor, transforming growth factor-beta, vascular endothelial growth factor and insulin like growth factor. Each growth factor has its own role with VEGF playing a role in the proliferation and differentiation of mesenchymal stem cells as well as angiogenesis.
The insulin like growth factor plays a role in neurite outgrowth and restores smooth muscle integrity while PDGF and transforming growth factor-beta play a role in angiogenesis and extracellular matrix and collagen synthesis.
FGF (fibroblast growth factor) acts as neuroprotection along with reducing fibrosis and increasing axonal myelination in the corpus cavernosum and nerve regeneration. All these functions are the reason PRP is successful in the treatment of erectile dysfunction.
Clinical Studies Comparing PRP and Shockwave for ED
Efficacy and Safety of Platelet Rich Plasma Intracavernous Injections for Patients with Erectile Dysfunction
Asian J Urol 2024 Jan 14;11(4):545-554 | PMID 39534000
Objective: Platelet Rich Plasma might offer improvement in erectile function since it has numerous growth factors. This study aimed to evaluate the efficacy and safety of PRP intracavernous injection for patients with ED.
Conclusion: Platelet Rich Plasma intracavernous injection may offer benefits in improving erectile function in patients with ED with a relatively good safety profile as proven by a significant increase in erection measurement scores tested at 1 month, 3 months and 6 months.
Reported adverse events were mild and self-limiting.
Retrospective Analysis of the Efficacy of Shockwave Therapy in ED Patients Responsive to PDE5Is
Sex Med 2024 Sep 29;12(4):qafe065 | PMID 39346801
Aim: The study aimed to suggest the early clinical efficacy of Li-ESWT and explore its related factors in young and middle-aged patients with ED who responded to phosphodiesterase type 5 inhibitors.
Conclusion: Shock wave therapy was more targeted and effective for young and middle-aged patients with erectile dysfunction who responded to PDE5Is.
Efficacy of PRP Alone or with Shockwave Therapy in ED
Aging Male 2025 Mar 4;28(1):2472786 | PMID 40037837
Background: The goal of this meta-analysis intended to identify the efficacy of platelet rich plasma alone or in combination with shock wave therapy as a therapy for erectile dysfunction.
Methods: seven randomized controlled trials with 660 patients were analyzed.
Conclusion: Compared with using shock wave therapy alone, the addition of PRP considerably increased the measurement scores of all ED patients tested.
Authors note: This study proves the efficacy of the combination of Platelet Rich Plasma with Shock Wave therapy for the treatment of Erectile Dysfunction.
Why PRP and Shockwave Are Better Together
The primary objective of regenerative therapy for the treatment of erectile dysfunction is to enhance the function of the endothelial cells. Both of these therapies enhance endothelial cells by promoting nitric oxide pathways thus improving vascular health and function of the penile blood vessels.
PRP and Shock Wave exhibited significant similarities in cellular mechanisms therefore they work synergistically when combined in the treatment of ED and should be used together to maximize therapeutic outcomes.
Juventix PRP Kits and Shockwave Devices for ED
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits are scientifically manufactured to provide a platelet concentrate, devoid of red blood cells with a minimum number of leukocytes that are critical for the regenerative process.
Juventix Regenerative Medical offers a patented LED Activator to activate the platelets and begin the regenerative process. The activation is a critical step in the release of the growth factors, cytokines and bioactive proteins from the granules that are contained on the platelets and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen.
This mode of activation by LED light provides sustained growth factor release versus older methods of activation while adhering to the minimal manipulation standards of the FDA. This activation should always be accomplished after the gentle swirl of the centrifuged product to maximize the number of captured platelets.
Juventix Regenerative Medical is proud to be a distributer of the PhysioPro Shock Wave System. This clinical grade radial shock wave device induces intracellular and extracellular reactions to assist in the repair and regeneration of tissues. The waves activate cellular pathways that drive the healing process.
Shock wave treatment stimulates angiogenesis and neogenesis. These metabolic processes form new blood vessels and improve nerve function which is critical in the treatment of erectile dysfunction. Treatments with the PhysioPro can also mobilize mesenchymal stem cells to migrate to the area for further cellular repair. Plaque formation which causes a decrease in blood flow can be destroyed. The safety of the use of the PhysioPro for conditions such as erectile dysfunction has been proven clinically in thousands of applications.
With the EDX, shock wave treatments can now be accomplished at home. This handheld shock wave device provides the benefits of shock wave treatment in the privacy of the home and has the same safety profile as the larger PhysioPro model.
Juventix Regenerative Medical has a vast array of products, devices and services tailored for the medical and regenerative professional. The PhysioPro, EDX, PRP Kits are a few of the many devices that offer the latest treatment options in regenerative medicine.
The regenerative marketplace is exploding with technological advancements being added daily for both men and women. With our premier line of products, services and devices and guidance through our experienced staff, Juventix will aid and guide any regenerative professional in providing enhanced outcomes and increased patient satisfaction.
RESTORE, REVIVE, REGENERATE – JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
