We assessed the safety and efficacy of 2 injections of platelet-rich plasma for treating mild to moderate erectile dysfunction by conducting a prospective, randomized, double-blind, placebo-controlled clinical trial. Men with mild to moderate erectile dysfunction (International Index of Erectile Function scores 11-25) were randomized to receive either 2 injections of platelet-rich plasma or placebo separated by 1 month. Primary outcome was percentage of men meeting minimum clinically important difference at 1 month after the second injection. Secondary outcomes were change in International Index of Erectile Function at 1, 3, and 6 months, and changes in penile vascular parameters and adverse events at 6 months. We randomized 61 men: 28 into platelet-rich plasma and 33 into placebo. There was no difference between groups in percentage of men meeting minimum clinically important difference at 1 month: 14 (58.3%) in platelet-rich plasma vs 15 (53.6%) in placebo (P = .730). Mean International Index of Erectile Function-Erectile Function domain changed from 17.4 (95% CI 15.8-19.0) to 21 (17.9-24.0) at 1 month in men receiving platelet-rich plasma, vs 18.6 (17.3-19.8) to 21.6 (19.1-24.1) in the placebo group; however, there was no significant difference between groups (P = .756). There were no major adverse events and only 1 minor adverse event in each group. There were no changes in penile Doppler parameters from baseline to 6 months. The results of our prospective, double-blind, randomized, placebo-controlled clinical trial suggest that 2 injections of intracavernosal platelet-rich plasma separated by 1 month in men with mild to moderate erectile dysfunction is safe, but we found no difference in efficacy between platelet-rich plasma and placebo.

Purpose of review: Several imaging modalities exist for the assessment of Peyronie's disease. However, comprehensive recommendations for using these objective modalities based on large-scale evidence-based studies do not yet exist. Our objective is to evaluate current imaging techniques and provide a model that we follow in our clinic in the workup and management of Peyronie's disease. Recent findings: Computed tomography and radiography excellently visualize penile plaque calcifications, and MRI adeptly identifies plaques in complex locations, such as the corporal septum. Ultrasonography has extensive applications in plaque localization and characterization. Used along with color Doppler ultrasound, it is capable of detecting vascular abnormalities. Sonoelastography is an emerging subtype of ultrasongraphy that utilizes elastic properties of tissue to identify penile plaques that may not be visualized with other modalities. Summary: Ultrasonography is the preferred imaging modality in Peyronie's disease and noninvasively characterizes penile plaques and monitors plaque response to various treatments. At our center, we perform ultrasonography with intracavernosal injection in all patients with Peyronie's disease to evaluate the degree of curvature, plaque characteristics, and concomitant erectile dysfunction to better guide management decisions.

Background: Male chronic pelvic pain syndrome (CPPS) is a heterogeneous constellation of symptoms that causes significant impairment and is often challenging to treat. In this prospective study, we evaluated men with CPPS who underwent comprehensive pelvic floor physical therapy (PFPT) program. We used the previously validated Genitourinary Pain Index (GUPI) to measure outcomes. Methods: We included 14 men who underwent physical therapy for idiopathic CPPS from October 2015 to October 2016. Men with clearly identifiable causes of pelvic pain, such as previous surgery, chronic infection, trauma, prostatitis and epididymitis were excluded. Treatment included: (I) manual therapy (internal and external) of pelvic floor and abdominal musculature to facilitate relaxation of muscles; (II) therapeutic exercises to promote range of motion, improve mobility/flexibility and strengthen weak muscles; (III) biofeedback to facilitate strengthening and relaxation of pelvic floor musculature; (IV) neuromodulation for pelvic floor muscle relaxation and pain relief. GUPI questionnaires were collected at initial evaluation and after the 10th visit. Higher scores reflect worse symptoms. Previous validation of the GUPI calculated a reduction of 7 points to robustly predict being a treatment responder (sensitivity 100%, specificity 76%) and a change in 4 points to predict modest response. Data are presented as medians (ranges). Results: A total of 10 patients completed 10 visits, and the remaining four patients completed between 5 and 9 visits. The median National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score at initial evaluation was 30.8 [16–39] and decreased to 22.2 [7–37] at the tenth visit. Five of the 10 patients (50%) in the study had a reduction of greater than 7 points indicating a robust treatment response, and two (20%) had a change of greater than 4 indicating moderate response. Three patients (30%) did not have any meaningful change in NIH-CPSI and the remaining four are in the process of completing 10 sessions. Duration of therapy appears to predict treatment response. Longer duration has better response. Conclusions: Male CPPS is difficult to treat and often requires a multimodal approach. Based on the results of our pilot study, pelvic floor rehabilitation may be an effective treatment option for select patients. A larger study with a control group is needed to validate the routine use of pelvic floor rehabilitation in men with CPPS and predict characteristics of men who would respond to therapy.

Introduction: We aimed to determine the time and predictive factors of semen quality improvement in men with severe oligospermia after microsurgical varicocelectomy. Methods: Men with total motile sperm count (TMSC) 6 months. We evaluated preoperative factors for successful semen quality upgrading based on assisted reproductive technology (ART) eligibility: in vitro fertilization [IVF] (9 million). We compared men with TMSC 6 months postoperatively. Results: A total of 33 men were included. TMSC improved from 1.5±0.2 to 7.3±1.8 million at 3–6 months (p6 months (p6 months. Sixteen (48.5%) men upgraded semen quality into the range of natural pregnancy. Preoperative TMSC from 2–5 million was predictive of upgrading semen quality. Twenty-four couples were contacted by phone; 20 were attempting pregnancy in the postoperative period and five (25%) of them had achieved natural pregnancy. Conclusions: Men with TMSC 2 million was most predictive of semen quality upgrading.