# Shockwave, PRP and stem cells for ED: what the guideline actually says > Low-intensity shockwave therapy, platelet-rich plasma (PRP) injections and stem cell injections are not established treatments for erectile dysfunction. The American Urological Association's ED guideline says shockwave therapy and intracavernosal stem cell therapy "should be considered investigational" and PRP "should be considered experimental." That verdict means the evidence is not settled, not that these therapies have been shown to fail. The options the guideline does tell men about are oral PDE5 inhibitors, vacuum erection devices, intraurethral and injected medicines, and penile implants. _Last updated: 2026-10-17_ --- Status: Investigational: not approved for ED (shockwave therapy and stem cell injections; PRP is classed as experimental). Source: AUA Erectile Dysfunction Guideline, Statements 23 to 25, checked 2026-10-17. **In short:** shockwave therapy, platelet-rich plasma (PRP) and stem cell injections are often marketed for erectile dysfunction, but none of them is an established ED treatment. The American Urological Association (AUA) guideline calls shockwave and stem cell therapy "investigational" and PRP "experimental." That is a verdict of "not established," not "does not work": the guideline does not say these therapies fail, and research on all three continues. Below: what each label means, what the newer reviews and other guidelines found, what else is being studied, which treatments the guideline does lay out, and the questions worth asking if a clinic offers you one of these. For the full range of established options, start with our guide to [ED treatment options](/ed-treatment-options), the first page in our [treatments beyond pills section](/topics/treatments/). ## Are shockwave, PRP and stem cells proven treatments for ED? No. The American Urological Association's erectile dysfunction guideline gives each of the three a cautious classification ([AUA Erectile Dysfunction Guideline]()): | Therapy | AUA guideline statement | Statement type and evidence level | | ----------------------------------------------------------- | ---------------------------------------------------- | -------------------------------------------------- | | Low-intensity extracorporeal shockwave therapy (Li-ESWT) | Statement 23: "should be considered investigational" | Conditional Recommendation; Evidence Level Grade C | | Intracavernosal stem cell therapy (injected into the penis) | Statement 24: "should be considered investigational" | Conditional Recommendation; Evidence Level Grade C | | Platelet-rich plasma (PRP) therapy | Statement 25: "should be considered experimental" | Expert Opinion | Put plainly, none of the three is among the treatment options the guideline says men with ED should be informed about. It also does not say they are harmful or useless. The honest summary is that they are still being studied, and the evidence so far is not strong enough to settle the question. ## What do "investigational" and "experimental" mean here? The statements themselves are one line each, but the guideline's own grading system explains why the labels are so cautious. A Grade C body of evidence is one the AUA panel holds with a low level of certainty: randomized trials with serious deficiencies or extremely small samples, or observational studies that are inconsistent, small or otherwise hard to interpret. A Conditional Recommendation is a non-directive statement used when the evidence shows no apparent net benefit or harm, or when the balance of benefits and risks is unclear, and with Grade C evidence the guideline says better evidence is likely to change confidence ([AUA guideline, methodology]()). PRP sits a step further back. Its statement is labeled Expert Opinion, which the AUA defines as a consensus of the panel based on clinical training, experience and judgment "for which there is no evidence." In other words, the PRP statement rests on the panel's judgment rather than on a graded body of evidence. One more piece of context: the guideline is dated 2018, and its literature search ran to July 2017. The AUA notes that guidelines are necessarily time-limited and cannot include evaluation of all data on emerging technologies. That is a good reason to look at newer research and at what other expert groups say, which the sections below do. For a primer on reading this kind of evidence, see [how to read ED evidence](/how-to-read-ed-evidence/). ## How does shockwave therapy work for ED? Low-intensity shockwave therapy sends sound waves into the penis with the aim of improving blood flow, as the 2025 Cochrane review describes it ([Cochrane review, 2025](https://pubmed.ncbi.nlm.nih.gov/40654049/)). A 2023 commentary in AUANews, the AUA's news magazine, by urologist Gregory Broderick explains that the waves used for ED are far lower in energy than those used to break up kidney stones, that the therapy "has been reported to induce angiogenesis," meaning the growth of new blood vessels, in animal penile tissue, and that clinics differ in the type of generator, the energy, the number of pulses and sessions, and whether the shaft alone or the shaft and the deeper base of the penis are treated ([AUANews, 2023](https://auanews.net/issues/articles/2023/march-2023/shock-wave-therapy-is-it-ethical-to-offer-and-charge-for-erectile-dysfunction-or-other-sexual-dysfunctions)). That variation is one reason the trials are hard to compare. The same commentary states plainly: "At this time, LiSWT is not FDA approved for ED." ## What does the research on shockwave therapy for ED show? Shockwave therapy has the most research of the three, and the most careful review of it still rates the evidence as low certainty. The 2025 Cochrane review included 21 randomized trials with 1,357 men, mostly with mild or mild-to-moderate ED, comparing shockwave therapy with a sham (fake) treatment ([Cochrane review, 2025](https://pubmed.ncbi.nlm.nih.gov/40654049/)). Its findings, in its own cautious terms: - In the short term (3 months or less), shockwave therapy **may have a small effect** on erectile-function questionnaire scores, about 3.9 points on a 30-point scale. The authors set 4 points as the smallest change men would notice, so this effect may not be clinically important. - In the longer term (more than 3 months), it **may improve** erectile function, based on 5 trials with 276 men. - It may make little to no difference in treatment-related side effects compared with sham. - The review found no evidence on patient or partner satisfaction or on sexual quality of life. - The certainty of evidence was **low for every outcome**, and several trials were industry-funded, mainly by device makers. The review excluded men who had had their prostate removed or a kidney transplant, so its findings do not speak to those groups. An earlier overview of eight systematic reviews rated seven of the eight as "critically low" on overall confidence and said the evidence should be considered carefully because of methodological flaws ([overview of systematic reviews, 2021](https://pubmed.ncbi.nlm.nih.gov/34733663/)). That overview did say the results supported shockwave as a complementary therapy, but the most rigorous assessment we found still lands on "may help, low certainty," which matches the guideline's "investigational" label. ## How long do shockwave therapy results last? Nobody knows yet, because few trials followed men for long. The Cochrane review found no trial with an active treatment period longer than three months ([Cochrane review, 2025](https://pubmed.ncbi.nlm.nih.gov/40654049/)). The AUANews commentary notes that in one meta-analysis of 16 randomized trials, only one followed men to 12 months, and concludes that "we do not have long-term efficacy data or know the impact of maintenance therapy" ([AUANews, 2023](https://auanews.net/issues/articles/2023/march-2023/shock-wave-therapy-is-it-ethical-to-offer-and-charge-for-erectile-dysfunction-or-other-sexual-dysfunctions)). The European Association of Urology (EAU) guideline describes any benefit as becoming evident one to three months after treatment and then decreasing progressively over time, though some effect could still be detected up to five years later in some studies ([EAU Guidelines, Management of ED](https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/management-of-erectile-dysfunction)). So "permanent" is not a word the evidence supports. ## What are the side effects of shockwave therapy for ED? The research so far suggests few. The Cochrane review found shockwave therapy may make little to no difference in treatment-related side effects compared with sham, in both the short and longer term, at low certainty ([Cochrane review, 2025](https://pubmed.ncbi.nlm.nih.gov/40654049/)). The AUANews commentary says guidelines agree the treatment appears safe and well tolerated, with penile pain and bruising the most common complications ([AUANews, 2023](https://auanews.net/issues/articles/2023/march-2023/shock-wave-therapy-is-it-ethical-to-offer-and-charge-for-erectile-dysfunction-or-other-sexual-dysfunctions)). A treatment being well tolerated is a separate question from whether it works. ## Do other guidelines see shockwave therapy differently? Yes, a little, and the difference is worth knowing if a clinic cites "the guidelines." The table sets out three expert positions on the same three therapies: | Therapy | AUA guideline (2018) | EAU guideline (current web edition) | SMSNA position statement (2021) | | ----------------- | ------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------- | | Shockwave therapy | "Investigational" | Weak recommendation for use in mild vasculogenic ED, for men who do not want or cannot take pills, and for poor responders to pills | Reserve for clinical trials, not routine practice | | PRP injections | "Experimental" (Expert Opinion) | Evidence insufficient for a recommendation; use only in a clinical trial | Reserve for clinical trials, not routine practice | | Stem cells | "Investigational" | Data insufficient for a clinical recommendation | Reserve for clinical trials, not routine practice | Sources: [AUA guideline](); [EAU Guidelines, Management of ED](https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/management-of-erectile-dysfunction); [SMSNA position statement, Sexual Medicine 2021](https://pubmed.ncbi.nlm.nih.gov/34000480/). "Vasculogenic" means ED driven by blood flow. The EAU's recommendation is graded "weak," and its text calls the improvement "modest." The Sexual Medicine Society of North America (SMSNA) concluded in 2021 that there is "an absence of robust clinical data" supporting restorative therapies for ED, though shockwave therapy has established relative safety, and that until larger, properly controlled trials are done, these therapies "should be reserved for clinical trials" ([SMSNA position statement](https://pubmed.ncbi.nlm.nih.gov/34000480/)). ## Do at-home or "radial" shockwave devices work for ED? There is little evidence that they do. The EAU guideline reports that a randomized trial using radial wave therapy showed no difference in erectile function or hardness scores between treatment and placebo groups ([EAU Guidelines, Management of ED](https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/management-of-erectile-dysfunction)). The AUANews commentary warns patients that radial devices produce "dispersive pressure waves of much lower energy and tissue penetration" than the focused low-intensity devices used in most trials ([AUANews, 2023](https://auanews.net/issues/articles/2023/march-2023/shock-wave-therapy-is-it-ethical-to-offer-and-charge-for-erectile-dysfunction-or-other-sexual-dysfunctions)). The trial evidence above, limited as it is, does not transfer to a different kind of device. ## What does the research on PRP injections for ED show? The research on PRP for ED is small, early and inconsistent in its methods. PRP is a preparation rich in factors involved in inflammation and the growth of new blood vessels, and for ED it is injected into the penis ([PRP meta-analysis, 2024](https://pubmed.ncbi.nlm.nih.gov/38590115/)). The published evidence: - A 2024 meta-analysis found only **3 randomized placebo-controlled trials with 230 men**. Those trials favored PRP on questionnaire scores, and the authors said higher-quality trials are needed to strengthen the findings ([PRP meta-analysis, 2024](https://pubmed.ncbi.nlm.nih.gov/38590115/)). - A 2023 systematic review noted that PRP for ED is widely used worldwide even though limited clinical data exist, that the mechanism behind any effect on erectile tissue remains undetermined, and that there is an "urgent need" for high-quality studies with long-term follow-up and standardized ways of preparing PRP ([PRP systematic review, 2023](https://pubmed.ncbi.nlm.nih.gov/37528499/)). - An earlier systematic review concluded that PRP for ED may be promising but that no recommendation can be made because the evidence is scarce, and suggested that patients be offered the chance to take part in trials ([PRP systematic review, 2022](https://pubmed.ncbi.nlm.nih.gov/34219010/)). - The EAU guideline describes the trials in more detail, including one in which PRP did no better than placebo, and concludes that PRP "should be used only in a clinical trial setting" ([EAU Guidelines, Management of ED](https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/management-of-erectile-dysfunction)). A 2024 network meta-analysis comparing all three therapies found statistically significant changes for PRP and shockwave, but its authors wrote that "the clinical relevance and extent of their impact remain questionable" ([regenerative therapies network meta-analysis, 2024](https://pubmed.ncbi.nlm.nih.gov/39419772/)). The AUA guideline's PRP statement still reads "experimental." ## What does the research on stem cell therapy for ED show? Stem cell therapy for ED is the least settled of the three. The human studies are few, small and varied: - A 2023 systematic review found 18 human trials with a total of 373 men, using at least six different kinds of stem cell or stem-cell-derived product. The authors said the lack of standardized techniques and of control groups in many studies makes the trials hard to evaluate or compare ([stem cell systematic review, 2023](https://pubmed.ncbi.nlm.nih.gov/37758225/)). - A 2025 meta-analysis could pool only 6 studies. It found higher questionnaire scores at six months compared with baseline, which was the longest follow-up reported, and said comparative trials with longer follow-up are needed before firmer conclusions can be drawn ([stem cell meta-analysis, 2025](https://pubmed.ncbi.nlm.nih.gov/40883730/)). - In the 2024 network meta-analysis, the stem cell estimate came with a wide credible interval that included no effect, and the authors concluded that further research is needed to determine whether stem cell therapy works for erectile function ([regenerative therapies network meta-analysis, 2024](https://pubmed.ncbi.nlm.nih.gov/39419772/)). Stem cell products also carry a regulatory point worth knowing. The FDA says regenerative medicine products such as stem cells require FDA approval to be marketed to consumers and, before approval, FDA oversight in a clinical trial. It states that the only FDA-approved stem cell products in the US are blood-forming stem cells from umbilical cord blood, approved for disorders that affect blood production and not for other uses ([FDA, regenerative medicine therapies](https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/important-patient-and-consumer-information-about-regenerative-medicine-therapies)). The FDA lists reported harms from unapproved products, including infections, tumor formation and blindness, and warns that if you are being charged for these products, or offered them outside a clinical trial, you are "likely being deceived." ## What is the latest treatment for erectile dysfunction? The newest options sit at very different stages, and only one has a US authorization. NIDDK, part of the National Institutes of Health, says researchers are studying new treatments for ED, how diet affects ED, and how to prevent ED after prostate surgery ([NIDDK, Clinical Trials for ED](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/clinical-trials)). Here is where the newer names stand: | Option | What it is | Where it stands | | ---------------------------------- | --------------------------------------------------------------------------- | ------------------------------------------------------------------- | | Eroxon gel | A drug-free topical gel regulated as a medical device | FDA granted its De Novo request on June 9, 2023 | | Shockwave therapy | Low-energy sound waves applied to the penis | AUA: investigational; not FDA approved for ED | | PRP injections | A platelet-rich preparation injected into the penis | AUA: experimental | | Stem cell injections | Cells or cell-derived products injected into the penis | AUA: investigational; FDA warns about unapproved stem cell products | | Botulinum toxin (Botox) injections | Injection into the penis, studied in men whom other treatments did not help | EAU: no recommendation yet; larger trials needed | | Apomorphine (under the tongue) | A dopamine-acting drug once licensed for ED in the EU | Not FDA-approved for ED; the EU authorization expired in 2006 | Sources: [FDA De Novo database, DEN220078](https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/denovo.cfm?id=DEN220078); [AUA guideline](); [AUANews, 2023](https://auanews.net/issues/articles/2023/march-2023/shock-wave-therapy-is-it-ethical-to-offer-and-charge-for-erectile-dysfunction-or-other-sexual-dysfunctions); [EAU Guidelines](https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/management-of-erectile-dysfunction); [EMA, Uprima](https://www.ema.europa.eu/en/medicines/human/EPAR/uprima). Eroxon is covered in detail in our guide to [ED creams and gels](/ed-creams-and-gels/), including how limited its main study was. Not every headline about ED drugs is about ED, either: research on sildenafil and dementia is a separate question, covered in [ED drugs and Alzheimer's research](/ed-drugs-and-alzheimers-research/). ## What is apomorphine for ED? Apomorphine is an older drug that acts on dopamine, a brain signaling chemical, rather than on blood vessels in the penis. A product called Uprima (apomorphine hydrochloride) was authorized for ED across the European Union on May 28, 2001. The European Medicines Agency says the company did not apply to renew it "for commercial reasons," so the authorization expired on May 28, 2006 ([EMA, Uprima](https://www.ema.europa.eu/en/medicines/human/EPAR/uprima)). Status: FDA-approved for another condition, not for ED (apomorphine injection, for "off" episodes in advanced Parkinson's disease). Source: APOKYN prescribing information, DailyMed, and EMA Uprima page, checked 2026-10-17. In the US, the apomorphine product on DailyMed is APOKYN, an injection for sudden "off" episodes in advanced Parkinson's disease ([APOKYN label, DailyMed](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3235535d-9ef9-4657-8b2a-176a807d091c)). A 2020 systematic review of nine randomized trials of apomorphine dissolved under the tongue for ED found it did better than placebo in most trials, by 6% to 27% more successful attempts, but not in men treated with radical prostatectomy, and more men stopped apomorphine than placebo because of side effects. The authors called for more trials ([Guillén et al., Archives of Sexual Behavior 2020](https://pubmed.ncbi.nlm.nih.gov/32964351/)). It is not an option a US pharmacy can fill for ED. ## Is Botox a treatment for ED? Not yet. The EAU guideline describes two randomized trials of botulinum toxin injected into the penis in men whose ED had not responded to pills or to injected ED medicines. Both reported improvement and only mild local side effects, but the guideline says "no recommendation for its use in clinical practice can be provided, as larger trials are needed" ([EAU Guidelines, Management of ED](https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/management-of-erectile-dysfunction)). Botox is not among the options the AUA guideline lays out. ## What ED treatments does the AUA guideline lay out? The guideline's statements say men with ED should be informed about a set of options, each with a discussion of its benefits and its risks or burdens ([AUA Erectile Dysfunction Guideline]()): - **Oral PDE5 inhibitors**, the FDA-approved pill class that includes sildenafil and tadalafil (Statement 8, Strong Recommendation). - **Vacuum erection devices** (Statement 13). - **Intraurethral alprostadil**, a medicine placed in the urethra (Statement 14). - **Intracavernosal injections**, medicine injected into the penis (Statement 16). - **Penile prosthesis implantation** (Statement 18). The guideline's stated purpose is that men be told about all treatments that are not ruled out for them, with the choice made together with a clinician. NIDDK describes a similar menu: lifestyle changes, counseling, PDE5 inhibitors, injectable medicines and suppositories, vacuum erectile devices, and surgery to implant a prosthesis ([NIDDK, Treatment for ED](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment)). The pill class is explained step by step in our guide to [how ED medications work](/how-ed-medications-work/), and each of the other options has its own page: [vacuum erection devices](/vacuum-erection-devices/), [injections and suppositories](/ed-injections-and-suppositories/) and [penile implants](/penile-implant/). If the question on your mind is whether ED can go away for good, our guide to [whether ED can be reversed](/can-ed-be-reversed/) covers which causes can improve when treated. ## What should you ask if a clinic offers shockwave, PRP or stem cells? If you are offered one of these newer therapies, it is reasonable to ask what evidence supports it and whether it is part of a study. A few plain questions help: - **What evidence supports this for my kind of ED?** The reviews above describe small trials, mixed methods and low-certainty evidence, so a confident sales pitch does not match the research. - **Is this part of a registered clinical trial?** For stem cell products, the FDA says use before approval requires FDA oversight in a clinical trial. It also warns that a listing on clinicaltrials.gov, or a claim that a product is "registered with FDA," does not by itself mean the product is legally marketed ([FDA, regenerative medicine therapies](https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/important-patient-and-consumer-information-about-regenerative-medicine-therapies)). NIDDK adds that NIH does not review every listed study and cannot ensure each one is safe, so talk with your own clinician before joining ([NIDDK, Clinical Trials for ED](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/clinical-trials)). - **What does the full course involve, and what does it cost?** The AUANews commentary suggests asking how many treatments there are, how often, what it costs, what your chances of benefit are, whether it could make things worse, and what the alternatives are ([AUANews, 2023](https://auanews.net/issues/articles/2023/march-2023/shock-wave-therapy-is-it-ethical-to-offer-and-charge-for-erectile-dysfunction-or-other-sexual-dysfunctions)). - **Has anyone looked for the cause of my ED?** The AUA guideline says men with ED should have a medical, sexual and psychosocial history, a physical exam and selective lab testing, and should be counseled that ED is a risk marker for underlying cardiovascular disease and other health conditions that may warrant evaluation ([AUA Erectile Dysfunction Guideline]()). Our guide on [when to see a doctor about ED](/when-to-see-a-doctor-about-ed/) covers what that visit looks like, and [what your ED says about your health](/ed-and-your-health/) explains why it matters. - **Have the guideline options been discussed with me?** The treatments listed above are the ones the guideline says men should be informed about, each with its benefits and burdens. A licensed clinician can walk through the established options, check what might be behind your symptoms, and tell you honestly whether a study of a newer therapy is worth considering. If you are also weighing over-the-counter products, our comparison of [natural remedies and medication](/natural-remedies-for-ed-vs-medication/) covers what the evidence says there. ## The bottom line Shockwave therapy, PRP and stem cell injections are still being studied for ED. The AUA guideline calls the first two "investigational" and PRP "experimental," the SMSNA says they belong in clinical trials, and the EAU's support for shockwave therapy is limited to a weak recommendation for mild, blood-flow-related ED. The newer reviews have not changed the overall picture: the evidence remains low in certainty, small in scale and uneven in method, and long-term data are thin. That is not proof that they fail. It does mean they are not established treatments, and that the options the guideline says men should be informed about (pills, devices, intraurethral and injected medicines, and implants) are the ones a conversation with a clinician can start from. ## Sources Every clinical and regulatory claim on this page traces to a primary source, a clinical guideline or a peer-reviewed review: - [American Urological Association, Erectile Dysfunction Guideline (2018)](): Statements 23 (Li-ESWT, investigational, Conditional Recommendation, Grade C), 24 (intracavernosal stem cell therapy, investigational, Conditional Recommendation, Grade C) and 25 (PRP, experimental, Expert Opinion); Statements 8, 13, 14, 16 and 18 on informing men about PDE5 inhibitors, vacuum erection devices, intraurethral alprostadil, intracavernosal injections and penile prosthesis; Statements 1 and 3 on evaluation and ED as a cardiovascular risk marker; the definitions of Grade C, Conditional Recommendation and Expert Opinion; the July 2017 literature search date. - [European Association of Urology, Guidelines on Sexual and Reproductive Health: Management of Erectile Dysfunction](https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/management-of-erectile-dysfunction): weak recommendation for low-intensity shockwave therapy in mild vasculogenic ED and related groups; modest improvement; timing and fading of effect; the negative radial wave trial; PRP only in a clinical trial setting; stem cell data insufficient; botulinum toxin trials and no recommendation. - [Liu JL, et al. Restorative Therapies for Erectile Dysfunction: Position Statement From the Sexual Medicine Society of North America. Sexual Medicine, 2021](https://pubmed.ncbi.nlm.nih.gov/34000480/): absence of robust clinical data; relative safety of shockwave therapy; restorative therapies reserved for clinical trials. - [Broderick GA. Shock Wave Therapy: Is It Ethical to Offer and Charge for Erectile Dysfunction or Other Sexual Dysfunctions? AUANews, March 2023](https://auanews.net/issues/articles/2023/march-2023/shock-wave-therapy-is-it-ethical-to-offer-and-charge-for-erectile-dysfunction-or-other-sexual-dysfunctions): LiSWT not FDA approved for ED; low energy compared with lithotripsy; reported effects in animal tissue; variation in devices, settings and target sites; lack of long-term data; penile pain and bruising as the most common complications; radial devices; questions for patients. - [NIDDK, Treatment for Erectile Dysfunction](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment) and [Clinical Trials for Erectile Dysfunction](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/clinical-trials), last reviewed October 2024: treatment options; research into new treatments, diet and prevention after prostate surgery; NIH does not review every listed study. - [Ergun O, et al. Low-intensity shockwave therapy for erectile dysfunction. Cochrane Database of Systematic Reviews, 2025](https://pubmed.ncbi.nlm.nih.gov/40654049/): 21 randomized trials, 1,357 men; low-certainty evidence for all outcomes; short-term difference of 3.89 points against a 4-point minimal important difference; possible longer-term improvement; little to no difference in side effects versus sham; no trial with active treatment longer than three months; men after prostate removal or kidney transplant excluded. - [Yuan F, et al. Low-intensity extracorporeal shockwave therapy for erectile dysfunction: an overview of systematic reviews. Translational Andrology and Urology, 2021](https://pubmed.ncbi.nlm.nih.gov/34733663/): seven of eight reviews rated critically low on overall confidence. - [Deabes M, et al. Platelet-rich plasma injection for erectile dysfunction: systematic review and meta-analysis of randomized controlled trials. Sexual Medicine Reviews, 2024](https://pubmed.ncbi.nlm.nih.gov/38590115/): 3 trials, 230 men; higher-quality trials needed. - [Alkandari MH, et al. Platelet-rich plasma injections for erectile dysfunction and Peyronie's disease: a systematic review of evidence. Sexual Medicine Reviews, 2022](https://pubmed.ncbi.nlm.nih.gov/34219010/): no recommendation possible because of scarce evidence; patients should be offered trial participation. - [Poulios E, et al. Platelet-rich plasma for the treatment of erectile dysfunction: a systematic review of preclinical and clinical studies. Sexual Medicine Reviews, 2023](https://pubmed.ncbi.nlm.nih.gov/37528499/): wide use despite limited clinical data; mechanism undetermined; urgent need for high-quality, standardized studies. - [Furtado TP, et al. Stem cell therapy for erectile dysfunction: a systematic review. Sexual Medicine Reviews, 2023](https://pubmed.ncbi.nlm.nih.gov/37758225/): 18 human trials, 373 men, several stem cell types; lack of standardized techniques and control groups. - [Senel S, et al. Stem cell therapy for erectile dysfunction: promise or reality? BMC Urology, 2025](https://pubmed.ncbi.nlm.nih.gov/40883730/): 6 studies pooled; scores higher than baseline at six months; comparative trials with longer follow-up needed. - [Hinojosa-Gonzalez DE, et al. Regenerative therapies for erectile dysfunction: a systematic review, Bayesian network meta-analysis, and meta-regression. Journal of Sexual Medicine, 2024](https://pubmed.ncbi.nlm.nih.gov/39419772/): 16 studies, 907 men; clinical relevance of shockwave and PRP results questionable; stem cell efficacy undetermined. - [Guillén V, et al. Apomorphine for the Treatment of Erectile Dysfunction: Systematic Review and Meta-Analysis. Archives of Sexual Behavior, 2020](https://pubmed.ncbi.nlm.nih.gov/32964351/): nine randomized trials; better than placebo in most; not significant after radical prostatectomy; more stopping for side effects. - [European Medicines Agency, Uprima (apomorphine hydrochloride)](https://www.ema.europa.eu/en/medicines/human/EPAR/uprima): EU authorization for ED on May 28, 2001; not renewed for commercial reasons; expired May 28, 2006. - [APOKYN (apomorphine hydrochloride injection) prescribing information, DailyMed](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3235535d-9ef9-4657-8b2a-176a807d091c): indicated for "off" episodes in advanced Parkinson's disease. - [FDA, De Novo database entry DEN220078 (Eroxon)](https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/denovo.cfm?id=DEN220078): De Novo request granted June 9, 2023. - [FDA, Important Patient and Consumer Information About Regenerative Medicine Therapies](https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/important-patient-and-consumer-information-about-regenerative-medicine-therapies): approval and clinical-trial oversight requirements; the only approved stem cell products; reported harms; the clinicaltrials.gov and registration caution. 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