The Experience of Combined Application of Platelet-Rich Plasma Therapy and Shock-Wave Therapy in Treatment of Erectile Dysfunction of Vascular Origin

2023

UJMH

Relevance. Today there is an additional progressive option to apply into the non-inflammatory CPPS, which is presented by regenerative medicine and specifically platelet-rich plasma(PRP) treatment. Aim – to evaluate efficacy of PRP treatment in combination with pharmacotherapy and ESWT for non-inflammatory CPPS. Materials and methods. Prospective study was conducted in a group of 40 outpatients with diagnosis of non-inflammatory chronic pelvic pain syndrome in Men’s Health Clinic (Kyiv, Ukraine). Mean age was equal to 46.4±10.2. The set of specific examinations included: trans-rectal prostate scanning, prostate secret sample analysis, visual analogue pain scale (VAS), International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5). Results. Study results showed that there are significant differences in mean VAS scores in time point at 28-th day of treatment where patients of MG demonstrated lower pain level (p<0.05) than patients of CG, meanwhile both groups had significant (p<0.05) decrease of pain levels in comparison with initial data. In 3 months after treatment, we could see elevation of pain in CG to the level that have no significant differences with initial data, while patients of MG still have significantly lower pain level, but difference between groups come insignificant. IPSS levels at 28-th day of treatment showed significant (p<0.05) efficacy (bringing symptoms from moderate to mild level) in both groups with lack of difference between them. Such situation was observer also in 3 months after treatment with slight increase of symptom intensity in both MG and CG. In 6 months after treatment, we have registered elevation of IPSS mean score in CG up to the level of insignificant difference with initial data. IIEF-5 data showed significant (p<0.05) improvement of symptoms at 28-th day of treatment in both CG and MG without significant difference between groups. In 3 months after treatment, we observed that in CG the level of symptoms raised to the level that have insignificant difference with initial data, but in MG the improvement was still significant. The same situation was observed in 6 months after treatment. Conclusions. The efficacy of PRP treatment in combination with pharmacotherapy and ESWT for non-inflammatory CPPS was evaluated. Significant clinical effects were found both for PRP combination with ESWT and NSAID and just ESWT and NSAID directly after course of treatment, meanwhile in 3 and 6 months after treatment the results start to show difference in favor of PRP inclusion.

mentioning

confidence: 99%

Modern Methods of Non-Inflammatory Chronic Pelvic Pain Syndrome Treatment

2023

UJMH

“…Large group of studies of PRP therapy prove this method to be highly effective in penile tissue regeneration due to MSCs biosignaling activation; restoration of vascular wall endothelial membrane by stimulating the endothelial progenitor cells and correction of endothelial dysfunction by optimization of eNOS and nNOS production [3,7,8].…”

mentioning

confidence: 99%

Erectile Dysfunction Treatment With Combination of Mesenchymal Stem Cell Derived Exosomes and Focused Low-Intensive Shock Wave Therapy

2020

UJMH

Relevance. Erectile dysfunction brings basic problem of urology, andrology and sexology. Erectile dysfunction have significant impact on quality of life, sexual and reproductive health and psychological condition in men. Novel experimental and clinical studies a several methods of regenerative medicine shoved simultaneous impact on main pathogenetic aims showing significant levels of clinical efficacy.Aim – to develop and analyze clinical effects of mesenchymal stem cell-derived exosomes intracavernous injections and low-intensity extracorporeal shock-wave therapy combination in patients with severe erectile dysfunction on background of metabolic syndrome and atherosclerosis.Materials and methods. A prospective clinical study was conducted on a contingent of 38 patients of “Men’s Health Clinic” (Kyiv, Ukraine) suffering from severe organic erectile dysfunction (ICD-10:N52.9; International index of erectile function score lower than 7) on the background of metabolic syndrome (ICD-10: E88.81) and generalized atherosclerosis (ICD-10: I70.9).Study results. Therapeutics model of combined application of mesenchymal stem cell-derived exosomes intracavernous injections and low-intensity extracorporeal shock-wave therapy showed significant positive impact of applied therapeutic model according to IIEF-5, EHS scores as well as due to pharmacodoppler-sonography data. Therapeutics model of application low-intensity extracorporeal shock-wave therapy also showed significant positive impact on same diagnostic categories.Conclusion. Comparison of post-therapeutic data between MG and CG showed absence of significant differences in all categories besides mean PSV, but values of statistical mistake probability are very close to significance threshold for IIEF-5 severe and moderate categories as well as EHS grades 4 and 2, what highlights perspective of further comparison studies on larger population scales, longer observation periods or less severe forms of ED.

Combination of Platelet Rich Plasma, Lowintensity Pulsed Ultrasound and Sildenafil Oral Spray in Treatment of Erectile Dysfunction

2019

UJMH

Relevance. Some non-pharmacological methods, such as low-intensity pulsed ultrasound (LIPUS) proved to be effective in ED treatment due to stimulation of penile tissue regeneration and penile hemodynamics increase. The biological methods that utilize cellular growth factors such as platelet-rich plasma (PRP) therapy proved to be effective in stimulation of neovascularization processes and correction of endothelial dysfunction while ED treatment.Local negative pressure (LNP) therapy shall be considered as an auxiliary method to PRP and LIPUS due to its ability to slow down PRP outflow from injection zones. Sildenafil («Strondex») is perspective pharmacological addition to ED treatment protocol. Aim. Evaluation of the efficacy and safety of therapeutic model of combined application of PRP intracavernous injections, LNP, LIPUS and Sildenafil («Strondex») for vasculogenic (arterial and corporal veno-occlusive) ED treatment.Materials and methods. Prospective study was conducted in a group of 64 outpatients with diagnosis of erectile dysfunction of vascular genesis (ICD-10: N48.4) in Men’s Health Clinic (Kyiv, Ukraine). “International Index of Erectile Function-5” (IIEF-5), “Erectile Hardness Score” (EHS) were used as the tools for clinical assessment. Ultrasonic cavernous bodies scanning and pharmacodopplersonography were used for the data validation.Study results. Main group patients underwent treatment consisting of 6 sessions of PRP intracavernous injections and 12 sessions of local penile LIPUS combined with LNP and Sildenafil («Strondex») pharmacotherapy. Control group underwent 12 sessions of local penile LIPUS combined with LNP and the same pharmacotherapy. According to the IIEF-5 data obtained 12 weeks after the study the erectile function improvement was found in 27 patients of the main group and 20 patients of the control group. EHS improved by 1 point or more in 29 and 20 patients correspondingly.Conclusions. Treatment protocol specifying combination of PRP, LIPUS, LNP and Sildenafil («Strondex») is promising due to PRP-therapy augmentation by intracavernous ultrasonic activation of platelet growth factors, but the data obtained require further physiological validation and clinical placebo-controlled studies with involvement of larger groups of population.