(253) REGENERATIVE THERAPIES FOR ERECTILE DYSFUNCTION: A SYSTEMATIC REVIEW, BAYESIAN NETWORK META-ANALYSIS, AND META-REGRESSION

Abstract Introduction Current guidelines advocate a shared decision-making process approach to erectile dysfunction (ED) management. There is growing interest in regenerative therapies such as stem cell therapy (SCT), platelet-rich plasma (PRP) injections, and low-intensity shockwave therapy (LiSWT) for ED. However, comparative data on the efficacy of these modalities are limited. Objective This systematic review and network meta-analysis aims to compare SCT, PRP injections, and LiSWT for managing ED and quantify their impact on the International Index of Erectile Function (IIEF). Methods In January 2024, a systematic search of online databases was performed to identify randomized clinical trials related to SCT, PRP and LiSWT for ED. Eligible articles reported outcomes using the IIEF score. Data was inputted into Review Manager 5.4 for pairwise meta-analysis. Data was 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 mean difference (MD) with 95% credible intervals (CrI). Meta-regression was used to determine coefficient of change and adjust for PDE5is use. Results A total of 17 studies involving 1,020 patients were analyzed. PRP with LiSWT led to the greatest increase in IIEF at a MD vs control of 8.2 IIEF [95% CrI 3.8, 13.0], followed by LiSWT alone with a MD vs control of 3.4 IIEF [95% CrI 2.1, 4.9], these findings are summarized in Fig. 1A. When stratifying interventions by dose, PRP with LiSWT led to the greatest increase in IIEF at a MD vs control of 10.0 IIEF [95% CrI 5.0, 16.0], followed by LiSWT 0.15 mJ/mm2 MD vs control of 5.7 IIEF [95% CrI 2.9, 8.6]. SCT showed no significant difference in IIEF scores, these findings are summarized in Fig. 1B. Meta-regression adjusting for the administration of PDE5 inhibitors yielded non-significant results. Conclusions Our findings underscored the effectiveness of LiSWT, PRP, and their combination as promising interventions for ED, with limited efficacy for SCT at this time. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Disclosures: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast, Halozyme Investor: Sprout.