Erectile Dysfunction (ED) is a common problem among men who have undergone Radical Prostatectomy (RP). This condition can be caused by nerve damage, low blood flow and deterioration of the tissue around the penis. Cell death has been linked to RP-ED in many studies, which can affect different parts of the penis, such as smooth muscle cells, supportive stromal cells and vascular cells.
Scientists have been looking into ways to repair these damaged cells, including injecting stem cells into the penis. However, it has been found that these stem cells may not actually become part of the tissue, but instead release substances that help the surrounding cells to repair themselves. This process is called a paracrine effect.
Phosphodiesterase type 5 inhibitors (PDE-5i) are a popular choice of treatment for ED, but unfortunately not everyone responds positively to them. As such, alternative treatments such as penile vacuum devices or injection therapy are sometimes suggested which are often unsatisfying experiences for patients leading some to drop out of treatment altogether.
However, recent studies have shown promising results in using stem cells from various sources to improve erectile function after RP. While this treatment is not yet widely available, it offers hope for men who struggle with ED after prostate surgery.
A study, A 12-Month Follow-up After a Single Intracavernous Injection of Autologous Adipose-Derived Regenerative Cells in Patients with Erectile Dysfunction Following Radical Prostatectomy: An Open-Label Phase I Clinical Trial, looked into the potential of stem cell therapy of patients who had recently undergone a radical prostatectomy.
Results of the Study
The study was conducted to see if injecting a patient’s own fat-derived stem cells into the penis could help with erectile dysfunction after prostate surgery. The study included 21 patients who were given a single injection of the stem cells into the penis, and they were monitored for 12 months for any adverse effects.
The patients received the injection under general anesthesia, and the stem cells were taken from their own abdominal fat tissue. Due to individual variations in the amount of subcutaneous fat available, the dose of the autologous ADRC (adipose derived regenerative cells) varied for each patient.
The primary endpoint of this study was to observe if there were any adverse events caused by this therapy within 12 months after the injection. Other secondary endpoints included evaluating sexual function and urinary continence using validated questionnaires such as IIEF-5, EHS and ICIQ-UI SF. Patients were asked about their ability to achieve an erection sufficient for intercourse as well.
At inclusion, 1, 3, 6 and 12 months after the injection, patients were evaluated for any change in symptoms or short term impacts on their health caused by the procedure. This innovative approach seeks to provide an effective treatment option for ED caused by RP with minimal side effects.
5 patients had full bladder control, while 6 were incontinent. All participants reported an active sex life before their radical prostatectomy, but 6 noted they had to use erectile aids prior to the surgery. Across both groups, the baseline characteristics such as age, BMI, smoking and alcohol intake were similar.
At 12 months post-treatment, 38% of all participants reported sufficient sexual activity for intercourse without erectile aids; with 3 men able to complete intercourse without erectile aids, and the other 5 using them with support from alprostadil injections, PDE-5i or penis rings. Prior to RP and throughout the period of observation following their stem cell treatment no patients recovered full erectile function.
At12 months post-treatment 8 out of 15 continent men (53%) improved their ESI scores significantly according to International Index of Erectile Function (IIEF) -5 score increase (median 9; IQR 13), as well as EHS data increase (median 2; IQR 2).
However, the study also found that the stem cell treatment did not have any effect on men who were experiencing ED before the prostate surgery. The study also found that there were no serious adverse effects related to the stem cell injection, although some men reported swelling, redness, and minor hematomas.
Overall, the study shows promise for men who are struggling with ED after prostate surgery, and offers a potential new treatment option. However, more research is needed to fully understand the effectiveness and safety of this treatment.
