Hinojosa-Gonzalez David E, Saffati Gal, Orozco Rendon Daniela, La Troy, Kronstedt Shane, Muthigi Akhil, Khera Mohit
Scott Department of Urology, Baylor College of Medicine, Houston, TX, 77030, United States.
Department of Urology, Houston Methodist, Houston, TX, 77030, United States.
J Sex Med. 2024 Dec 1;21(12):1152-1158. doi: 10.1093/jsxmed/qdae131.
Current guidelines advocate a shared decision-making process approach to erectile dysfunction management, and while there is growing interest in regenerative therapies such as stem cell therapy, platelet-rich plasma injections, and low-intensity shockwave therapy for erectile dysfunction, comparative data on the efficacy of these modalities are limited.
This systematic review and network meta-analysis aims to compare stem cell therapy, platelet-rich plasma injections, and low-intensity shockwave therapy for managing erectile dysfunction and quantify their impact on the International Index of Erectile Function (IIEF).
In January 2024, a systematic search of online databases was performed to identify randomized clinical trials related to stem cell therapy, platelet-rich plasma injections, and low-intensity shockwave therapy in erectile dysfunction. Eligible articles reported outcomes using the IIEF score. Data were inputted into Review Manager 5.4 for pairwise meta-analysis. Data were then used to build a network in R Studio. These networks were used to model 200 000 Markov Chains via MonteCarlo sampling. The results are expressed as standardized mean difference (SMD) with 95% credible intervals (CrI). Meta-regression was used to adjust for PDE5is use.
Impact on the International Index of Erectile Function.
A total of 16 studies involving 907 patients were analyzed. The standardized mean difference (SMD) vs control for stem cell therapy was 0.92 [95% CrI -0.49, 2.3]. For platelet-rich plasma, the SMD vs control was 0.83 [95% CrI 0.15, 1.5], and for low-intensity shockwave therapy, the SMD vs control was 0.84 [95% CrI 0.49, 1.2]. When stratifying low-intensity shockwave therapy by dose, the SMD vs control at 0.15 mJ/mm2 was 1.1 [95% CrI 0.36, 1.9], while at 0.09 mJ/mm2, it was 0.75 [95% CrI 0.26, 1.2]. Meta-regression adjusting for the administration of PDE5 inhibitors yielded non-significant results.
The findings suggest that stem cells, platelet-rich plasma, and low intensity shockwave therapy, particularly at 0.15 and 0.09 mJ/mm2, may offer improvements in erectile function.
The strength is the robust statistical methods. Limitations are in heterogeneity in control groups and follow-up durations among included studies.
Shockwave therapy and platelet-rich plasma demonstrated statistically significant improvements, though the clinical relevance and extent of their impact remain questionable. Further research is necessary to determine the efficacy of stem cell therapies for erectile function.
当前指南提倡采用共同决策过程的方法来管理勃起功能障碍，虽然诸如干细胞疗法、富血小板血浆注射和低强度冲击波疗法等再生疗法对勃起功能障碍的治疗越来越受到关注，但关于这些疗法疗效的比较数据有限。
本系统评价和网状Meta分析旨在比较干细胞疗法、富血小板血浆注射和低强度冲击波疗法治疗勃起功能障碍的效果，并量化它们对国际勃起功能指数（IIEF）的影响。
2024年1月，对在线数据库进行系统检索，以识别与勃起功能障碍的干细胞疗法、富血小板血浆注射和低强度冲击波疗法相关的随机临床试验。符合条件的文章使用IIEF评分报告结果。数据输入Review Manager 5.4进行成对Meta分析。然后将数据用于在R Studio中构建网络。这些网络通过蒙特卡洛抽样用于模拟200,000个马尔可夫链。结果以标准化均数差（SMD）和95%可信区间（CrI）表示。采用Meta回归调整PDE5抑制剂的使用情况。
对国际勃起功能指数的影响。
共分析了16项研究，涉及907例患者。干细胞疗法与对照组相比的标准化均数差（SMD）为0.92 [95% CrI -0.49, 2.3]。富血小板血浆与对照组相比的SMD为0.83 [95% CrI 0.15, 1.5]，低强度冲击波疗法与对照组相比的SMD为0.84 [95% CrI 0.49, 1.2]。按剂量对低强度冲击波疗法进行分层时，0.15 mJ/mm2时与对照组相比的SMD为1.1 [95% CrI 0.36, 1.9]，而在0.09 mJ/mm2时为0.75 [95% CrI 0.26, 1.2]。调整PDE5抑制剂使用情况的Meta回归得出无显著结果。
研究结果表明，干细胞、富血小板血浆和低强度冲击波疗法，尤其是在0.15和0.09 mJ/mm2时，可能会改善勃起功能。
优点是统计方法稳健。局限性在于纳入研究中对照组的异质性和随访时间。
冲击波疗法和富血小板血浆显示出统计学上的显著改善，但其临床相关性和影响程度仍存在疑问。有必要进一步研究以确定干细胞疗法对勃起功能的疗效。
