H. Merrill Matschke, MD

Try Dr Mohit Khera with Baylor Urology. He is truly a reknowned expert in sexual medicine.  Not simply a provider of a P shot.

Every man will respond to PRP in the penis differently.  Anyone guaranteeing more length or girth should be considered suspect.  The possible improvements include: improved sensation, improved erectile quality, enhancement in girth and length, improvement in deformity from peyronies disease, and more confidence/satisfaction with sexual activity in general.  Best results are always obtained with a comprehensive evaluation, examination and discussion with the gentleman.  PRP alone will NOT be nearly as effective as a multifaceted approach to improving sexual function.  Most importantly, concomitant use of a vacuum device, optimization of nitric oxide and hormonal status, and consideration of synergy with shockwave therapy will increase the probability of getting the most out of a penile PRP injection.  As a provider that performs penile PRP injections via an optimal approach, many of my patients report improvement in girth and length--but certainly not all.  Expectations must be realistic.

PRP for the penis--also called the P shot is directed at the internal erectile structures of the penis and NOT the superficial skin layers.  Thus the Pshot would not be expected, nor should ever be promoted, as a treatment to improve the skin of the penis.  PRP works at the level of the smooth muscle/vascular tissue in the deepest aspects of the penile anatomy---inside the corpora cavernosa.  Unfortunately, anyone claiming this PRP could "migrate" out to the superficial tissues is not being truthful.  

Robust data shows that Acoustic wave, better known as shockwave, therapy improves ED in about 70-85% of cases.  This is a general percentage addressing all people seeking the treatment, but a focused consultation with provider knowledgeable in erectile dysfunction can provide a much better estimate of success for any given man's specific ED problem.  There are several different causes of ED, and the success rate will depend on both the underlying causes AND the severity/duration of the problem.  Your best bet is to find a provider dedicated to sexual medicine, and ideally a urologist with deep knowledge of the anatomy and nuances of erectile function. 

We have had excellent results with shockwave therapy, but it may not always be the best choice of treatment depending on the underlying causes and any associated factors.  To achieve the best results, the man's hormonal and vascular status must be optimized.  Many centers are now introducing shockwave therapy as an option in their offerings for ED treatment--largely because the data proves it is effective.  To get optimal results, look for providers with an extensive history in treating all male sexual dysfunction problems because you will ultimately get better results and a more honest approach. 

The best answer as to how this therapy works is that it helps to restore the function of the smooth muscle cells of the corpora cavernosa.  The health of these smooth muscle cells are the key to the hydraulic mechanism within the penis.  Shockwaves cause these cells, and the tissue around them, to secrete the body's own growth and healing factors. These growth factors restore and rejuvenate the smooth muscle cells so they respond and work much better--like they were when the man was younger.  The end result, in the appropriately chosen man, is to restore the normal hydraulics to the erectile cylinders in the penis.  That is a brief explanation of a fairly complex biologic process, but the beauty of it is that we have solid data available that proves this mechanism.  

I hope that helps you understand that shockwave therapy for ED is not only effective in the appropriately chosen man, but that it should be first line treatment since it is addressing the underlying problem leading to the dysfunction instead of just treating the symptom which is what the meds like Viagra and Cialis do!   

The success of acoustic wave for ED is more based upon the severity of the changes within the erectile tissue itself and less about the associated conditions.  In other words, the worse the ED is to begin with--the lower the success rate from acoustic wave therapy.  As a group, about 70-85% of men will note improvement from acoustic wave therapy (also known as shockwave).  To be fully transparent though, success rates should only be quoted once a discussion is had about the severity/duration of the problem, other medical issues, medications, etc.  For instance, a man that has had his prostate removed for cancer and then had further radiation for a cancer recurrence is going to have a much lower chance for improvement than a man with only mild erectile difficulties.  

Shockwave therapy helps by restoring the normal "hydraulics" of penis and this can result in both improvement in getting and maintaining the erection.  The longer a man has had the problem and the more severe the problem are the keys to knowing if shockwave has a good chance of helping.  The fact that you have some ability to obtain an erection suggests that you have some healthy erectile tissue in the two hydralic cylinders known as the corpora cavernosa, and this is good predictor of having a positive response to shockwave.  In no way, however, in my experience (as a urologist) should shockwave be promoted, or expected, to treat symptoms related to BPH. 

Bottom line is yes, shockwave has the potential to help for ED in your case, but not for BPH symptoms.

Hope that helps!