What is the "P-Shot"?
The P-Shot, also known as a platelet-rich plasma (PRP) injection, is being tested as an experimental therapy for erectile dysfunction (ED).
It involves taking a sample of the patient’s blood, using a centrifuge to separate out the PRP from the other components of blood (i.e., red blood cells and platelet-poor plasma), and injecting the PRP into the penis to promote the growth of penile tissues.
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How does the P-Shot work?
In theory, the PRP would act as an agent to repair damaged tissues in the penis, leading to better erections. According to some, the P-shot can improve blood flow to the penis, create stronger erections, improve sensation and performance, and even increase penile length and girth.
Despite numerous claims of its efficacy, PRP remains a hotly debated topic of discussion in the field of sexual medicine.
Currently, there is a very limited number of peer-reviewed studies that have tested the safety and effectiveness of PRP in treating ED in humans.
The P-Shot. Results in rats
A few studies have published results that show improvements in the erectile function of rats with the use of PRP. While encouraging, these findings cannot be applied to humans, which is why it is so important to have controlled human studies that replicate these results.
One study aimed to do so by testing the effectiveness of PRP in treating urologic conditions in 17 different patients, including four patients with ED and one patient with both ED and Peyronie’s disease (PD). On average, the patients received 2.1 PRP injections for their condition(s). The injections were well tolerated by the patients overall, and the only reported side effects were mild pain at the site of injection (3 out of the 17 patients) and slight bruising in the area (1 patient).
None of the ED and/or PD patients in this study experienced worse erectile function after receiving PRP injections, as measured by the International Index of Erectile Function (IIEF-5). The IIEF-5 scores of the patients increased an average of 4.14 points after PRP therapy. However, since the patients were being treated for different conditions, did not receive the same number of injections, and were not compared to a control group, the researchers were unable to draw definitive conclusions about the effectiveness of PRP in treating ED.
The first double-blind, randomized, placebo-controlled trial to evaluate the efficacy of PRP therapy in treating ED was published in May 2021. For this study, a group of 60 sexually active patients with mild to moderate ED were randomly assigned to one of two groups: the PRP therapy group or the control group. Both groups received two intracavernosal injections spaced one month apart, but the 30 men in the PRP group received PRP injections, and the 30 men in the control group received placebo injections.
The P-Shot: Conclusion
The participants’ erectile function was assessed at baseline and at 1, 3, and 6 months after their final treatment using the IIEF – Erectile Function Domain. More than half (69%) of the men in the PRP group achieved a minimal clinically important difference (MCID) in their IIEF scores at the 6-month mark, compared to 27% of the men in the control group. No adverse side effects were reported, and the men in the PRP group were more satisfied with their treatment. While these results are positive, the authors point out that the extent of the improvement was limited, and it remains unclear whether PRP therapy results in long-term improvement.
These studies and others like them provide a good starting point, but more research needs to be done to determine whether PRP could be a safe and effective treatment option for ED.
In a statement on restorative therapies for ED, the Sexual Medicine Society of North America (SMSNA) acknowledged that PRP might be effective for regenerating erectile tissues, but at this point, there is simply not enough evidence to recommend it as a medical treatment.
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References
Krzastek, S.C., Bopp, J., Smith, R.P., & Kovac, J.R. (2019). Recent advances in the understanding and management of erectile dysfunction. F1000Research, 8. DOI: 10.12688/f1000research.16576.1
Liu, J.L., Chu, K.Y., Gabrielson, A.T., Wang, R., Trost, L., Broderick, G., Davies, K., Brock, G., Mulhall, J., Ramasamy, R., & Bivalacqua, T.J. (2021). Restorative therapies for erectile dysfunction: position statement from the Sexual Medicine Society of North America (SMSNA). Sexual medicine, 9(3), 100343. DOI: https://doi.org/10.1016/j.esxm.2021.100343
Matz, E.L., Pearlman, A.M., & Terlecki, R.P. (2018). Safety and feasibility of platelet rich fibrin matrix injections for treatment of common urologic conditions. Investigative and clinical urology, 59(1), 61-65. DOI: https://doi.org/10.4111/icu.2018.59.1.61
Poulios, E., Mykoniatis, I., Pyrgidis, N., Zilotis, F., Kapoteli, P., Kotsiris, D., Kalyvianakis, D., & Hatzichristou, D. (2021). Platelet-rich plasma (PRP) improves erectile function: a double-blind, randomized, placebo-controlled clinical trial. The journal of sexual medicine, 18(5), 926-935. DOI: 10.1016/j.jsxm.2021.03.008
Scott, S., Roberts, M., & Chung, E. (2019). Platelet-rich plasma and treatment of erectile dysfunction: critical review of literature and global trends in platelet-rich plasma clinics. Sexual medicine reviews, 7(2), 306-312. DOI: https://doi.org/10.1016/j.sxmr.2018.12.006
Wu, C.C., Wu, Y.N., Ho, H.O., Chen, K.C., Sheu, M.T., & Chiang, H.S. (2012). The neuroprotective effect of platelet‐rich plasma on erectile function in bilateral cavernous nerve injury rat model. The journal of sexual medicine, 9(11), 2838-2848. DOI: https://doi.org/10.1111/j.1743-6109.2012.02881.x
