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| Efficacy and safety of platelet-rich plasma intracavernous injection for patients with erectile dysfunction: A systematic review, meta-analysis, and meta-regression |
Sally Suharyania,Moses Leonardoa,Heru Harsojo Oentoengb,Edwin Raja Pardamean Lumban Tobingc,Christiano Tansolc,Timotius Ivan Hariyantoa,*( )
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aFaculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
bDepartment of Andrology and Sexual Medicine, Siloam Hospitals Kebon Jeruk, Jakarta, Indonesia
cDepartment of Urology, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia |
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Abstract Objective: Intracavernous injection might be offered to patients with erectile dysfunction (ED) who did not respond to the first-line oral treatment. Platelet-rich plasma (PRP) might offer improvement in erectile function since it contains numerous growth factors. This study aimed to evaluate the efficacy and safety of PRP intracavernous injection for patients with ED. Methods: We conducted relevant literature searches on Cochrane Library, Medline, Scopus, and ClinicalTrials.gov ↗ databases using specific keywords. The results of continuous variables were pooled into the mean difference (MD) and dichotomous variables into the odds ratio along with 95% confidence interval (95% CI). Results: A total of six studies were included. Our pooled analysis revealed that PRP intracavernous injection was associated with a significant increase in the erectile function domain of the International Index of Erectile Function at 1 month (MD 3.47 [95% CI 2.62-4.32], p<0.00001, I2=7%), 3 months (MD 3.19 [95% CI 2.25-4.12], p<0.00001, I2=0%), and 6 months (MD 3.21 [95% CI 2.30-4.13], p<0.00001, I2=0%) after the intervention when compared with baseline values. PRP was also superior to a placebo in terms of improvement in erectile function domain of the International Index of Erectile Function score at 1 month (MD 2.83, p<0.00001), 3 months (MD 2.87, p<0.00001), and 6 months (MD 3.20, p<0.00001) post-intervention. The adverse events from PRP injection were only mild without any serious adverse events. Conclusion: PRP intracavernous injection may offer benefits in improving erectile function in patients with ED with a relatively good safety profile.
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Received: 01 March 2023
Available online: 20 October 2024
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Corresponding Authors:
*E-mail address: timotius.hariyanto95@gmail.com (T.I. Hariyanto).
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The Preferred Reporting Items for Systematic reviews and Meta-Analyses diagram of the detailed process of selection of studies for inclusion in the systematic review and meta-analysis.
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| Study | Design | Sample size, n | PRP injection dose | ED severity, % | ED duration,montha | Age, mean,year | BMI, mean,kg/m2 | HT, % | DM,% | Smoker,% | | Poulios et al., 2021 [17] | Double-blind RCT | • 60 (intervention group: 30; control group: 30) | •
Two sessions of PRP injection (1 month apart): a total of 5 mL PRP was infused in each corpus cavernosum over a 2 min period | ·-
Mild: 33
·-
Mild to moderate: 54
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Moderate: 13 | 78.7±54.6 | 57.7 | 28.8 | 30 | 25 | 58 | | Schirmann et al., 2022 [18] | Prospective study | • 15 | •
Three sessions of PRP injection (15 days apart): 3 mL PRP was injected into each corpus cavernosum (total 6 mL) with additional of 6 mL injected subcutaneously | ·-
Moderate: 60
·-
Severe: 40 | NA | 56.1 | NA | 46.7 | 66.7 | 93.3 | | Shaher et al., 2023 [19] | Double-blind RCT | • 100 (intervention group: 50; control group: 50) | •
Two sessions of PRP injection (2 weeks apart): 3 mL PRP was injected into each corpus cavernosum at three different sites: 1 cm proximal to the corona, 1 cm distal to the root of penis, and at the mid-penile shaft | ·-
Mild: 28
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Mild to moderate: 53
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Moderate: 19 | 43.5±14.1 | 54.9 | 25 | 32 | 32 | 55 | | Ta? et al., 2021 [20] | Prospective study | • 31 | •
Three sessions of PRP injection (15 days apart): 3 mL PRP was injected into each corpus cavernosum with sites of injection varying by 1 cm in the mid-penile region | - NA | 64.2±46.6 | 54.4 | 30.8 | 51.6 | 51.6 | NA | | Wong et al., 2021 [21] | Prospective study | • 30 | •
Three sessions of PRP injection (3 weeks apart): 1-2 mL PRP was injected into each corpus cavernosum | - NA | 25.7 | 54.9 | 25.7 | 40 | 16.7 | 30 | | Zaghloul et al., 2021 [22] | Prospective study | • 34 | •
Eight sessions of PRP injection (1 week apart): 0.5 mL PRP was injected into each corpus cavernosum (total of 1 mL) | - NA | 26.5±23.8 | 50.2 | NA | 5.9 | 38.2 | 35.3 |
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Characteristics of included studies.
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Risk of bias assessment of the included studies using the Risk of Bias version 2 tool.
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Risk of bias assessment for non-randomized intervention study by using the Risk of Bias in Non-randomized Studies of Interventions tool. Notes: D1 represents the bias due to confounding; D2 represents the bias due to selection of participants; D3 represents the bias in classification of interventions; D4 represents the bias due to deviations from intended interventions; D5 represents the bias due to missing data; D6 represents the bias in measurement of outcomes; D7 represents the bias in selection of the reported result.
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Forest plot that demonstrates the efficacy of post platelet-rich plasm intracavernous injection for patients with erectile dysfunction in terms of erectile function domain of International Index of Erectile Function outcomes at different time when compared with baseline values. (A) 1 month; (B) 3 months; (C) 6 months. CI, confidence interval; SD, standard deviation; IV, inverse-variance.
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Forest plot that demonstrates the efficacy of post-PRP intracavernous injection for patients with erectile dysfunction in terms of changes in the IIEF-EF outcome at different time when compared with the placebo: (A) 1 month; (B) 3 months; (C) 6 months; and the post-PRP intracavernous injection and the number of patients with minimal clinically important difference in the IIEF-EF scores outcome at different time when compared with a placebo:(D) 1 month; (-) 3 months; (F) 6 months. CI, confidence interval; IIEF-EF, the erectile function domain of International Index of Erectile Function; PRP, platelet-rich plasma; SD, standard deviation; IV, inverse-variance; M-H, Mantel-Haenszel.
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