Efficacy of autologous adipose-derived stromal vascular fraction and platelet-rich plasma intracavernous injections in patients with erectile dysfunction: a retrospective comparative study

Vasculogenic erectile dysfunction (ED) is primarily driven by impaired penile hemodynamics, and conventional phosphodiesterase type 5 inhibitors (PDE5i) may offer limited benefit in patients with persistent endothelial dysfunction. Regenerative therapies such as platelet-rich plasma (PRP) and adipose-derived stromal vascular fraction (AD-SVF) have emerged as potential alternatives; however, comparative clinical data remain limited. This retrospective study included 60 men with non-severe, PDE5i-refractory vasculogenic ED (International Index of Erectile Function-5 [IIEF-5] > 10) treated with either PRP ( n = 30) or AD-SVF ( n = 30) between April and September 2022. Changes in erectile function and penile hemodynamics were evaluated using IIEF-5 scores and peak systolic velocity (PSV) using penile Doppler ultrasonography at 3, 6, and 12 months following treatment. Both treatment modalities were associated with significant improvements in erectile function over time. At 3 months, PRP resulted in greater short-term improvement in IIEF-5 scores compared with AD-SVF (+ 3.7 ± 2.4 vs. +1.0 ± 1.3; p < 0.001). At 6 months, AD-SVF demonstrated significantly greater improvements in IIEF-5 (+ 5.2 ± 1.7 vs. +3.7 ± 2.4; p = 0.007) and PSV (+ 3.0 ± 1.5 vs. +0.9 ± 1.1 cm/s; p < 0.001), with PRP outcomes remaining stable from 3 months onwards, indicating early functional plateau. At 12 months, AD-SVF gains were maintained (ΔIIEF-5: +5.4 ± 2.0 vs. +3.7 ± 2.4; p = 0.004; ΔPSV: +3.2 ± 1.7 vs. +1.0 ± 1.1 cm/s; p < 0.001). Subgroup analyses suggested more pronounced vascular benefits of AD-SVF in patients with hypertension and hyperlipidemia, whereas PRP showed a more uniform, moderate effect across subgroups. No serious adverse events were observed. In this retrospective, real-world analysis of men with PDE5i-refractory vasculogenic ED, PRP was associated with faster short-term functional improvement, whereas AD-SVF demonstrated greater and more sustained gains from 6 months onwards. These findings should be interpreted as exploratory and hypothesis-generating, underscoring the need for prospective, controlled trials to better define the role of regenerative therapies in vasculogenic ED.