Restorative therapy clinical trials for erectile dysfunction: a scoping review of endpoint measures

A contemporary review of the treatments and challenges associated with penile rehabilitation after radical prostatectomy including a proposed optimal approach

Prostate cancer is one of the most prevalent malignancies affecting men worldwide. Despite advancements in understanding prostate anatomy and minimally invasive approaches to surgical treatment, surgery can have significant adverse effects on sexual function. Penile rehabilitation strategies have emerged as a promising approach to mitigate the impact of prostate cancer treatments on erectile function and improve quality of life. Several methods have been employed for penile rehabilitation, including pharmacotherapy, vacuum erection devices, intracavernous injections, and emerging novel techniques. Yet, there is no consensus on the exact programs or timing of initiation that should be utilized for optimal recovery after surgery. This review discusses various rehabilitation protocols and long-term outcomes and explores the cost-effectiveness of different interventions. Additionally, this review discusses the importance of a multidisciplinary approach to penile rehabilitation which includes patient education, counseling, and the selection of an appropriate rehabilitation strategy tailored to each individual's needs and preferences. Continued research and collaboration among healthcare professionals are essential to refine rehabilitation approaches and ensure optimal outcomes for patients with prostate cancer.

Regenerative Therapy in Erectile Dysfunction: A Survey on Current Global Practice Trends and GAF Expert Recommendations

PURPOSE

This study aimed to examine current global practices in regenerative therapy (RT) for erectile dysfunction (ED) and to establish expert recommendations for its use, addressing the current lack of solid evidence and standardized guidelines.

MATERIALS AND METHODS

A 39-question survey was developed by senior Global Andrology Forum (GAF) experts to comprehensively cover clinical aspects of RT. This was distributed globally via a secure online Google Form to ED specialists through the GAF website, international professional societies, and social media, the responses were analyzed and presented for frequencies as percentages. Consensus on expert recommendations for RT use was achieved using the Delphi method.

RESULTS

Out of 479 respondents from 62 countries, a third reported using RT for ED. The most popular treatment was low-intensity shock wave therapy (54.6%), followed by platelet-rich plasma (24.5%) and their combination (14.7%), with stem cell therapy being the least used (3.7%). The primary indication for RT was the refractory or adverse effects of PDE5 inhibitors, with the best effectiveness reported in middle-aged and mild-to-moderate ED patients. Respondents were confident about its overall safety, with a significant number expressing interest in RT's future use, despite pending guidelines support.

CONCLUSIONS

This inaugural global survey reveals a growing use of RT in ED treatment, showcasing its diverse clinical applications and potential for future widespread adoption. However, the lack of comprehensive evidence and clear guidelines requires further research to standardize RT practices in ED treatment.

A primer on the restorative therapies for erectile dysfunction: a narrative review

INTRODUCTION

Erectile dysfunction (ED) is a common condition that affects millions worldwide. Patients and urologists alike are seeking alternative therapies that can provide long-lasting results in the treatment of ED. This review provides a comprehensive overview of restorative treatments available for ED, such as platelet-rich plasma, stem cell therapy, and shockwave therapy.

OBJECTIVE

The aim of this narrative review is to provide a primer for urologists and general practitioners on the basics of implementing ED restorative therapies in their practice.

METHODS

The PubMed, MEDLINE, and Google Scholar databases were searched for articles in the English language through August 31, 2023, that included key terms such as "erectile dysfunction," "restorative therapy," "shockwave therapy," "platelet-rich plasma," "stem cell therapy," and "stromal vascular fraction." Reference lists of selected studies were manually reviewed to find articles not identified by the initial database search.

RESULTS

Shockwave therapy has demonstrated effectiveness in treating ED, with devices like the Medispec ED1000 and Storz Duolith showing statistically significant improvements in patient scores for International Index of Erectile Function (IIEF)-Erectile Function scores in clinical trials. In reported studies of platelet-rich plasma injections, a substantial percentage of patients reached a minimal clinically important difference in the IIEF-Erectile Function scale after treatment. Studies of ED treatment with stem cell therapy, while limited and with small sample sizes, have demonstrated encouraging improvements in patient scores for the abridged 5-item version of the IIEF after treatment.

CONCLUSION

Shockwave, platelet-rich plasma, and stem cell therapies are important, novel, noninvasive restorative treatments for ED that can provide relief for patients wishing to avoid a more invasive approach. While these therapies have shown promising results in clinical trials, more research is required to establish them as standardized and efficacious options in the management of ED.

Stem-Cell, Shockwave, and Platelet Rich Plasma Therapy for the Treatment of Erectile Dysfunction and Peyronie's Disease: A Survey of Clinics Across the USA

OBJECTIVE

To identify clinics offering off-label therapies for erectile dysfunction (ED) and Peyronie's disease (Pyd) including stem cell, platelet-rich plasma (PRP), and shockwave therapy and to determine the transparency they provided to patients inquiring about these treatment modalities.

METHODS

Clinics were identified in different regions in the US using a systematic search on online website directories and were approached by asking a series of standardized questions regarding the cost of treatment, duration of therapy, the medical staff involved, and patient outcome data. A total of 26 clinics were surveyed for stem cell therapy, 26 for PRP treatment, and 27 for shockwave therapy.

RESULTS

Of the 79 clinics contacted, 93.7% provided some answers to the questions we asked, with a majority offering treatments for both ED and Pyd. The cost of treatment varied widely between clinics. The average cost per stem cell therapy injection was $5291, PRP per injection was $1336, and shockwave therapy per session was $413. A physician was involved in 67% of treatments, and only 6 of 79 clinics reported that a urologist was involved. Over 75% of the clinics reported patient satisfaction following treatment. Durability of benefits to patients ranged from months to years according to the clinics' reports.

CONCLUSION

Our data not only demonstrate the widespread use of off-label therapies for ED and PyD across the United States but also the lack of scientific data to support the claims made to patients. This study highlights the need for more oversight and standardization in novel regenerative therapies for ED and PyD.

ChatGPT's Ability to Assess Quality and Readability of Online Medical Information: Evidence From a Cross-Sectional Study

Introduction Artificial Intelligence (AI) platforms have gained widespread attention for their distinct ability to generate automated responses to various prompts. However, its role in assessing the quality and readability of a provided text remains unclear. Thus, the purpose of this study is to evaluate the proficiency of the conversational generative pre-trained transformer (ChatGPT) in utilizing the DISCERN tool to evaluate the quality of online content regarding shock wave therapy for erectile dysfunction. Methods Websites were generated using a Google search of "shock wave therapy for erectile dysfunction" with location filters disabled. Readability was analyzed using Readable software (Readable.com, Horsham, United Kingdom). Quality was assessed independently by three reviewers using the DISCERN tool. The same plain text files collected were inputted into ChatGPT to determine whether they produced comparable metrics for readability and quality. Results The study results revealed a notable disparity between ChatGPT's readability assessment and that obtained from a reliable tool, Readable.com (p<0.05). This indicates a lack of alignment between ChatGPT's algorithm and that of established tools, such as Readable.com. Similarly, the DISCERN score generated by ChatGPT differed significantly from the scores generated manually by human evaluators (p<0.05), suggesting that ChatGPT may not be capable of accurately identifying poor-quality information sources regarding shock wave therapy as a treatment for erectile dysfunction. Conclusion ChatGPT's evaluation of the quality and readability of online text regarding shockwave therapy for erectile dysfunction differs from that of human raters and trusted tools. Therefore, ChatGPT's current capabilities were not sufficient for reliably assessing the quality and readability of textual content. Further research is needed to elucidate the role of AI in the objective evaluation of online medical content in other fields. Continued development in AI and incorporation of tools such as DISCERN into AI software may enhance the way patients navigate the web in search of high-quality medical content in the future.

Assessing the quality and readability of online content on shock wave therapy for erectile dysfunction

Patients are becoming increasingly reliant on online platforms for obtaining health information. Previous research has shown that the quality of information available on the internet regarding novel medical therapies is generally poor and frequently misleading. Shock wave therapy represents a novel restorative therapy for erectile dysfunction (ED) that has recently gained attention. We hypothesised that online sources regarding shock wave therapy for ED would be fraught with misleading claims and unreliable health information. Our objective was to evaluate the quality and readability of online medical information on shock wave therapy as a treatment for ED. Websites were generated using a Google search of 'shock wave therapy for erectile dysfunction' with location filters disabled. Readability was analysed using the Readable software (Readable.com, Horsham, United Kingdom). Quality was assessed independently by three reviewers using the DISCERN tool. Articles were subdivided into those from private clinic websites and those from universities or news media websites. Statistical analysis was conducted using the Student's t test. Nine articles that resulted from the Google search had mean readability scores as follows: Flesch-Kincaid grade level (10.8), Gunning-Fog Index (13.67), Coleman-Liau Index (12.74), Simple Measure of Gobbledygook (SMOG) Index (13.33), FORCAST Grade Level (11.33), and Automated Readability Index (11.08). The mean Flesch Reading Ease score was 46.4. The articles had a mean DISCERN score of 3.1, suggesting 'moderate quality' content. Articles from universities (n = 2) or news sources (n = 3) had significantly higher DISCERN scores than articles from private medical practices (n = 4). There was no difference in readability scores between the groups. Articles from private clinics are just as readable as those from universities or news media, but they are significantly more biased and misleading. The current online material relating to shock wave therapy for ED may not adequately inform patients in their medical decisions making, thereby necessitating closer collaboration between the sources disseminating information and urologists.