The common practice of injecting platelet rich plasma (PRP) for male sexual rejuvenation (the p shot) was evidenced only in animal models until recently. Erectile dysfunction (ED) is a vaso-neuro condition that affects 40% of men at age 40 and 70% of men by age 70.¹ Traditional treatment options have include pharmaceuticals such as Viagra and Levitra which can come with major side effects.² The safety of PRP injections is well known, and a recent clinical trial shows the efficacy of PRP for erectile dysfunction in humans.
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Study Shows Safety and Efficacy of the “P” Shot
The 2014 trail included 17 participants with a variety of urologic conditions; 4 men with erectile dysfunction (ED), 11 with Peyronie’s (PD), a man with both ED and PD and one woman with stress urinary incontinence (SUI).³ Each participant received an average of 2.1 PRP injections in a single session and were then followed for and average of 15.5 months. Outcomes were measured with the International Index of Erectile Function (IIEF-5) Questionnaire. The study found the injections were safe and well tolerated.
PRP was prepared by filing two separate test tubes with 9 ml of peripheral blood. The collection tubes were spun in a centrifuge at 6000 rpms for 6 minutes. The supernatant was collected then activated with 10% calcium chloride at a 1:10 ratio. Each tube yielded 5.5 ml of Platelet Rich Fibrin Matrix (PRFM; also know as activated PRP).
Patients received one or two injections depending on the condition. Men with ED received a intracavernosal injection, men with PD received injections directly into tunical plaques under ultrasound guidance. The SUI patient received an injection into urethral submucosa, distal to the bladder neck, using a pediatric cystoscope and transurethral injection needle. Researchers injected the PRFM within 10 minutes of activating the clotting cascade with calcium chloride. Administering injections within 10 minutes prevented the solution from washing out of the target area.
The study found 4 participants experienced mild pain, one reported bruising, and no major adverse events. PRFM is a second generation PRP preparation that has higher hematocrit levels than pure PRP. The increase in hematocrit levels is known to increase pain at injection site, but benefits the reconstruction of damaged vasculature by creating a scaffold for tissue ingrowth.
The trail was designed to assess safety and efficacy of PRP injections. IIEF-5 scores increased an average of 4.14 points after PRP treatment. Nine of the 11 PD participants reported subjective improvement in the degree of penile curvature. The SUI patient experienced a 50% reduction in episodes of incontinence. Future trials would benefit from reporting platelet counts at baseline and in the final solution, as well as the addition of a control group to assess placebo.³
Erectile Dysfunction and PRP Injections
Erectile dysfunction is defined as the inability to maintain an erection for satisfactory sexual performance. This condition affects 1 in 4 men and is positively correlated to age, smoking status and vascular diseases such as hypertension and diabetes. Healthy vasculature and nervous functions are key to maintaining an erection. The process depends on the parasympathetic nervous system, which induces the relaxation of cavernous smooth muscles and the dilation of penile arterioles through nitric oxide pathways.
The psychological factors associated with ED are well known. Future studies are necessary to determine the role of placebo when using PRFM injections to treat ED. Patients distressed by the diagnosis may feel a sense of relief after receiving a promising treatment, allowing them to better access the parasympathetic pathway that initiates erections. Biologically, the platelets will secrete growth factors, tiny bioactive proteins, that increase potential healing through angiogenesis.⁴
PRP Therapy and Peyronie’s Disease
Peyronie’s disease (PD) presents as visible curvature of the penis which can make erections painful and intercourse impossible. The cause of PD is still unclear, researchers speculate the deformity occurs from dysregulated healing of microtraumas. After injury, fibrous tissues forms as plaque inside the tunica albuginea which leads to painful curvature. But PD has also been diagnosed in sexually naïve men suggesting that penile microtrauma is only part of the story. Peyronie’s often occurs along with ED, diabetes and cardiovascular disease.
The use of PRFM injections at the tunical plaque could help to alleviate Peyronie’s by increasing collagenase production. Activated platelets begin to release growth factors that regulate collagenase production such as platelet derived growth factor, transforming growth factor, and epidermal growth factor. Collagenase could help to correct the deformed tissue by reforming tropocollagen.⁵
Stress Urinary Incontinence and PRP Injections
Stress urinary incontinence (SUI) is clinically defined as bladder leakage while under exertion such as sneezing, coughing, or laughing. SUI leakage occurs without the urge to relieve. Incontinence preceded or accompanied by a sense of urgency is known as urge urinary incontinence (UUI). SUI affects anywhere from 4-35% of women.⁶ The condition can dramatically affect quality of life.
The pathophysiology of SUI includes; prolapse conditions, congenital or acquired sphincter dysfunction, and issues with urethral pressure. If urethral hyper-mobility is found with the use of upright cystourthrography, then the patient could benefit from better urethral support and a surgery is often recommended.⁷ PRP would benefit this type of SUI patient by supporting tissue regeneration. If urethral mobility is not found, PRP would still potentially benefit patients with sphincter dysfunction by releasing growth factors at the site of dysfunctional tissue.
- Lakin, M, Wood H. Erectile Dysfunction. Cleveland Clinic Center for Continuing Education. Nov 2012.[clevelandclinic]
- Lim PH, Li MK, Ng FC, et al. Clinical efficacy and safety of sildenafil citrate (Viagra) in a multi-racial population in Singapore: A retrospective study of 1520 patients. Int J Urol. 2002;9(6):308-15.[ncbi]
- Matz EL, Pearlman AM, Terlecki RP. Safety and feasibility of platelet rich fibrin matrix injections for treatment of common urologic conditions. Investigative and Clinical Urology. 2018;59(1):61-65. doi:10.4111/icu.2018.59.1.61.[ncbi]
- Kovac JR, Labbate C, Ramasamy R, Tang D, Lipshultz LI. Effects of cigarette smoking on erectile dysfunction. Andrologia. 2015;47(10):1087-1092. doi:10.1111/and.12393.[ncbi]
- Kayes O, Khadr R. Recent advances in managing Peyronie’s disease. F1000Research. 2016;5:F1000 Faculty Rev-2372. doi:10.12688/f1000research.9041.1.[ncbi]
- Luber KM. The Definition, Prevalence, and Risk Factors for Stress Urinary Incontinence. Reviews in Urology. 2004;6(Suppl 3):S3-S9.[ncbi]
- McGuire EJ. Pathophysiology of Stress Urinary Incontinence. Reviews in Urology. 2004;6(Suppl 5):S11-S17.[ncbi]
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