Clinical Effects and Safety Outcomes of Platelet-Rich Plasma Therapy in Patients With Vasculogenic Erectile Dysfunction: A Systematic Review and Meta-Analysis

Abstract

Purpose: Erectile dysfunction (ED) significantly impacts quality of life and intimate relationships. ED results from a complex interaction of physiological, psychological, and lifestyle factors. While conventional treatments focus on symptom management, regenerative therapies like platelet-rich plasma (PRP) aim to address underlying causes, offering curative potential. However, evidence for PRP's efficacy in vasculogenic ED remains inconclusive. This systematic review and meta-analysis (SRMA) evaluates the effectiveness of penile PRP injections for vasculogenic ED and updates clinical guidelines based on recent evidence. Materials and Methods: Conducted per MOOSE guidelines and registered with PROSPERO (CRD42023430295), this SRMA included observational studies and randomized controlled trials (RCTs) assessing PRP for vasculogenic ED. The PECOS framework guided eligibility, focusing on RCTs comparing PRP to placebo for meta-analysis. Data on study characteristics, PRP protocols, and outcomes using validated erectile function measures and penile Doppler parameters were extracted. Quality was assessed using Cochrane risk of bias and CONSORT guidelines. Statistical analysis employed random or fixed-effects models based on heterogeneity, with publication bias evaluated via funnel plots. Results: Of 111 abstracts screened, 28 met inclusion criteria, and 3 RCTs alongside 2 observational comparative studies were reviewed. Meta-analysis of the RCTs showed significant improvement in erectile function for PRP versus placebo (mean difference 3.28, 95% confidence interval 1.46-5.11, p<0.001). Sensitivity analysis confirmed result's robustness, and no publication bias was detected. Side effects were rare, with isolated cases of plaque formation and hematoma. Studies combining PRP with low-intensity shock wave therapy showed enhanced efficacy.