COMBINATION OF PLATELET RICH PLASMA, LOWINTENSITY PULSED ULTRASOUND AND SILDENAFIL ORAL SPRAY IN TREATMENT OF ERECTILE DYSFUNCTION
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.
2. Seabaug K. A. et al. Extracorporeal Shockwave Therapy Increases Growth Factor Release from Equine Platelet-Rich Plasma In Vitro // Frontiers in Veterinary Science. 2017. № 4. P. 205.
3. Lei H. et al. Low-intensity shock wave therapy and its application to erectile dysfunction // World J. Mens Health. 2013. Vol. 31. P. 208–214.
4. Xin Z. et al. Clinical applications of low-intensity pulsed ultrasound and its potential role in urology // Transl. Androl. Urol. 2016. Vol. 5, № 2. P. 255–266.
5. Pounder N. M., Harrison A. J. Low intensity pulsed ultrasound for fracture healing: A review of the clinical evidence and the associated biological mechanism of action // Ultrasonics. 2008. Vol. 48, № 4. P. 330–338.
6. Khanna A. et al. The effects of LIPUS on soft-tissue healing: A review of literature // Brit. Med. Bull. 2009. Vol. 89. P. 169–182.
7. Yu. I. Zaseda et al. The experience of combined application of platelet-rich plasma therapy and shock-wave therapy in treatment of erectile dysfunction of vascular origin // Чоловіче здоров’я, гендерна та психосоматична медицина. 2018. № 1. P. 5-14.
8. Способ лечения эректильной дисфункции: пат. № 2514639 РФ.; заявл. 05.03.2014; опубл. 27.04.2014, Бюл. № 12.
9. Горпинченко И. И. Современное лечение эректильной дисфункции. Использование ингибиторов фосфодиэстеразы 5-го поколения // Здоровье мужчины. 2013. № 3 (46). С. 87–90.
10. Горпинченко І. І., Воробець Д. З., Свердан П. Л. Еректильна дисфункція та пов’язана зі здоров’ям якість життя // Здоровье мужчины. 2010. № 1 (32). С. 54–60.
11. Cui W et al. Efficacy and safety of novel low-intensity pulsed ultrasound (LIPUS) in treating mild to moderate erectile dysfunction: a multicenter, randomized, double-blind, sham-controlled clinical study // Transl. Androl. Urol. 2019. Vol. 8, P. 307-319.
This work is licensed under a Creative Commons Attribution 4.0 International License.