Intracavernosal Exosomes vs. Rectal Ozone for Post-RARP Erectile Dysfunction

Overview

This prospective, randomized, controlled trial aims to evaluate and compare the therapeutic efficacy of intracavernosal urine-derived exosomes and systemic rectal ozone therapy in patients experiencing erectile dysfunction (ED) post-robotic-assisted radical prostatectomy (RARP). Patients will be randomized into two distinct intervention arms. The primary objective is to assess the functional recovery of the erectile tissue via the International Index of Erectile Function (IIEF-5) over a 6-month follow-up period. Secondary endpoints include penile hemodynamic alterations and overall health-related quality of life.

Erectile dysfunction (ED) remains a prevalent and distressing complication following robotic-assisted radical prostatectomy (RARP), primarily manifesting secondary to cavernous nerve neuropraxia, subsequent localized hypoxia, and fibrotic remodeling of the corpus cavernosum. While standard pharmacotherapies (e.g., PDE5 inhibitors) offer symptomatic relief, they fail to reverse the underlying endothelial and neural detriments.Recent preclinical and clinical data suggest that stem cell-derived therapies, particularly cell-free exosomes, exhibit significant proangiogenic and antifibrotic properties. Extracellular vesicles containing components of the stem cell secretome, such as microRNAs, facilitate endothelial cell proliferation and tissue repair. Conversely, systemic ozone therapy has been hypothesized to enhance oxygen delivery, upregulate antioxidant enzymes, and modulate inflammatory cascades, potentially mitigating post-surgical ischemia. In this trial, eligible post-RARP patients will be randomized (1:1) to receive either a targeted intracavernosal injection of urine-derived exosomes (USC-Exos) or a scheduled regimen of rectal ozone-oxygen mixture insufflation. Erectile capacity, penile vascular hemodynamics (assessed via pharmacopenile duplex ultrasonography), and general health status will be prospectively monitored at baseline, 3, and 6 months post-intervention.