The Potential of Platelet-Rich Plasma (PRP) Injections and Stem Cell Therapy for Penile Rejuvenation
- 3 days ago
- 5 min read
Introduction
Penile rejuvenation is an evolving field in urology aimed at addressing erectile dysfunction (ED), Peyronie’s disease, and age-related structural penile changes. While phosphodiesterase type 5 inhibitors (PDE5i), intracavernosal injections, and surgical interventions remain foundational, they often address only symptoms rather than underlying tissue degeneration.
Regenerative medicine strategies—particularly Platelet-Rich Plasma (PRP) injections and stem cell therapy—offer the potential to restore tissue integrity by promoting angiogenesis, neurogenesis, and fibrosis modulation. These minimally invasive, autologous approaches may complement conventional treatments and provide new therapeutic options for carefully selected patients.
Platelet-Rich Plasma (PRP) Therapy
Mechanism: PRP leverages the regenerative potential of platelets to stimulate tissue repair and angiogenesis in penile tissue. Platelets contain alpha granules that release a complex cocktail of growth factors, cytokines, and chemokines, which collectively mediate tissue regeneration:
Vascular Endothelial Growth Factor (VEGF): Promotes endothelial cell proliferation and capillary formation, enhancing penile microvascular perfusion.
Platelet-Derived Growth Factor (PDGF): Stimulates smooth muscle cell proliferation, aiding in restoration of corporal tissue integrity.
Transforming Growth Factor-β (TGF-β): Modulates collagen synthesis and extracellular matrix remodeling, potentially reducing fibrosis associated with Peyronie’s plaques.
Insulin-Like Growth Factor (IGF-1): Supports neuronal regeneration and may improve penile innervation.
Epidermal Growth Factor (EGF): Contributes to epithelial and endothelial repair.
Mechanistic Insights: PRP not only enhances vascularization but also recruits local progenitor and stem cells via chemotactic signaling. It modulates inflammatory responses and encourages tissue remodeling, making it particularly useful in early-stage ED and mild Peyronie’s disease. PRP appears to act as both a biological scaffold and signaling enhancer, amplifying endogenous regenerative pathways.
Preparation
Blood Collection: 30–60 mL autologous blood with anticoagulant (ACD-A or CPD).
Centrifugation:
Single-spin: 1500 g × 10 min (~2–3× platelet concentration).
Double-spin (preferred): First 1000–1200 g × 10 min, then 1500–2000 g × 10 min (~3–5× platelet concentration).
Activation (Optional): Calcium chloride or thrombin; otherwise rely on tissue thrombin.
Injection Technique
Site: Intracavernosal, lateral shaft, avoiding dorsal neurovascular bundle.
Volume: 3–5 mL divided along shaft.
Needle: 25–27G, 1–1.5 inch.
Frequency: 3–4 sessions, 4–6 weeks apart.
Adjuncts: PDE5 inhibitors or low-intensity shockwave therapy may enhance effects.
Clinical Outcomes & Safety
Improves IIEF scores in mild to moderate ED.
Reduces plaque size and may improve curvature in early Peyronie’s disease.
Well-tolerated; mild swelling, pain, or hematoma are most common.
Rare systemic complications due to autologous origin.
Monitoring
Functional outcomes (IIEF), penile Doppler, and patient satisfaction should be assessed at baseline, 1, 3, and 6 months post-treatment.
Figure 1. Outlines the three primary clinical stages of Platelet-Rich Plasma (PRP) Therapy. This autologous treatment uses a patient's own blood to promote healing and tissue regeneration.
Figure 2. Schematic representative of platelet lysate (PL) injections. Six Injection sites viewed from underneath of penis indicate by syringe icons (A). Injection is shown in cross-section view of penis (B)
Stem Cell Therapy
Mechanism: Mesenchymal stem cells (MSCs), derived from adipose tissue, bone marrow, or umbilical cord, promote penile tissue regeneration via:
Cellular differentiation: Into endothelial cells, smooth muscle cells, and neurons.
Paracrine signaling: Secretion of trophic factors and exosomes stimulates angiogenesis, neurogenesis, and tissue repair.
Anti-fibrotic effects: Modulates extracellular matrix remodeling, potentially reversing early Peyronie’s plaques.
Preparation
Source: Adipose-derived (ADSCs) or bone marrow-derived MSCs; autologous preferred.
Processing: SVF isolation (for ADSCs) or bone marrow mononuclear cell prep; >90% cell viability recommended.
Dosing: 10–50 × 10^6 viable cells per injection, 2–5 mL total volume.
Injection Technique
Site: Intracavernosal for ED; perilesional for Peyronie’s disease.
Needle: 22–25G.
Frequency: Usually a single session; optional repeat after 3–6 months.
Adjuncts: PDE5 inhibitors, PRP, or low-intensity shockwave therapy may enhance regenerative outcomes.
Clinical Outcomes & Safety
Early human trials show improved IIEF scores and penile rigidity in mild to moderate ED.
May reduce plaque formation and improve curvature in early Peyronie’s disease.
Generally safe; local swelling or mild hematoma most common. Long-term safety data are limited.
Monitoring
Functional outcomes (IIEF), penile Doppler, and imaging for tissue remodeling should be assessed at baseline, 1, 3, and 6 months post-treatment.
Figure 3. Graphical abstract Intra‑cavernosal injection (ICI) of adipose‑derived stem cells (ADSCs) ameliorates erectile dysfunction via multiple synergistic mechanisms. ADSCs differentiate into neurons, smooth muscle cells, and endothelial cells, thereby contributing directly to tissue regeneration. In addition, their paracrine activity results in the secretion of numerous trophic factors and exosomes that stimulate angiogenesis, neurogenesis, and nerve regeneration while concurrently suppressing inflammation. Collectively, these effects culminate in enhanced erectile function
Comparative Insights
Feature | PRP | Stem Cells |
Source | Autologous platelets | Autologous/allogeneic MSCs |
Mechanism | Growth factor–mediated repair | Cellular differentiation + paracrine signaling |
Invasiveness | Minimal | Moderate (harvest + injection) |
Evidence Level | Early clinical studies | Preclinical + early clinical trials |
Safety | Excellent, mainly local effects | Generally safe; long-term effects under study |
Adjunct Potential | Synergistic with PDE5i/LiSWT | Synergistic with PDE5i, PRP, LiSWT |
PRP provides a minimally invasive, growth factor‑driven stimulus to support penile tissue repair and vascular function, making it suited to early ED and mild Peyronie’s disease. Stem cell therapy, although requiring more complex preparation and a slightly more invasive delivery, offers broader regenerative potential through cellular differentiation and paracrine signaling, potentially yielding longer‑lasting structural benefits. Both approaches are generally safe and may work synergistically with therapies such as PDE5 inhibitors or low‑intensity shockwave therapy to enhance functional outcomes.
Figure 4. (a): Intracavernous injection of epinephrine (b): Left dorsal penile nerve block (c): Right dorsal penile nerve block
Clinical Considerations
Patient Selection: Early-stage ED, mild Peyronie’s, or age-related tissue atrophy respond best.
Protocol Standardization: Document platelet concentration, cell source, volume, and session frequency for reproducibility.
Adjunct Therapy: PDE5i or LiSWT may improve outcomes.
Monitoring: IIEF, penile Doppler, plaque assessment, and patient satisfaction surveys recommended.
Safety: Both therapies are well-tolerated; mild swelling, pain, or hematoma most common.
Conclusion
PRP and stem cell therapies represent promising regenerative strategies in penile rejuvenation, targeting underlying mechanisms of ED and tissue degeneration. While early clinical data are encouraging, careful patient selection, standardized protocols, and adjunctive strategies are essential for safe and effective implementation. Combination therapies may leverage synergistic effects, and future large-scale trials will clarify efficacy, optimal dosing, and long-term outcomes.
References:
Israeli, J. M., Lokeshwar, S. D., Efimenko, I. V., Masterson, T. A., & Ramasamy, R. (2022). The potential of platelet‑rich plasma injections and stem cell therapy for penile rejuvenation. International Journal of Impotence Research, 34(4), 375–382. https://doi.org/10.1038/s41443‑021‑00482‑z
Ghavam, A., Sheikhnia, F., Heidari, M. M., Valilo, M., Mahmoudnejad, Z., & Gur, S. (2025). An updated narrative review on revolutionizing erectile dysfunction treatment: The crucial role of trophic factors in adipose‑derived stem cell therapy. BMC Urology, 25(1), Article 206. https://doi.org/10.1186/s12894‑025‑01861‑0
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