Regenerative therapy and medication compared
Two different approaches to the same problem. One treats the symptom, the other targets the underlying tissue. Both have their place. Here you will find what you need to know to make an informed choice.
Two mechanisms of action
PDE5 inhibitors (sildenafil, tadalafil) improve blood flow to the erectile tissue by inhibiting an enzyme. The effect is temporary and must be taken again each time. Regenerative therapy (shockwave and PRP) aims to restore the blood vessel structure itself. That is a slower process, but the goal is a more lasting effect.
Both approaches have advantages and limitations. The choice depends on your symptoms, your medical history, and your personal preference. Often they complement each other.
Side by side
| Aspect | Regenerative therapy | PDE5 inhibitors |
|---|---|---|
| Mechanism of action | Stimulates blood vessel formation and tissue repair in the erectile tissue. The body does the work itself. | Inhibits the PDE5 enzyme, causing smooth muscle cells to relax and temporarily improving blood flow. |
| Duration of effect | Builds up over 3 to 6 months. Results can last 12 months or longer. | Per dose, 4 to 36 hours depending on the drug. No cumulative effect. |
| Administration | Sessions at the clinic, 15 to 25 minutes each. PRP requires a blood draw. | Tablet or orodispersible, taken at home. On prescription from your GP or urologist. |
| Side effects | Mild and temporary: slight tingling or sensitivity after a session. No systemic effects. | Headache, flushing, nasal congestion, stomach complaints, visual disturbances. Rarely serious, but consistently present. |
| Who is it suitable for | Mild to moderate vasculogenic erectile problems. SHIM score 8 to 21. Not suitable for severe anatomical abnormalities. | Broadly applicable for most forms of ED. Not suitable when using nitrates or with severe cardiovascular conditions. |
| Scientific evidence | Cochrane review 2025: cautiously positive, evidence level "low", average improvement "mild". PRP: experimental according to the EAU. | Extensively studied, high evidence level. Over 25 years of clinical use. |
| Can they be combined? | Yes. Regenerative therapy can improve the response to medication. Men who no longer responded to PDE5 inhibitors sometimes showed renewed sensitivity after shockwave. | Yes. Can be continued alongside regenerative therapy. |
Combination as a promising route
In some men, the combination of both approaches works better than either one alone. Shockwave can restore sensitivity to PDE5 inhibitors in men who had stopped responding. In clinical practice, we see this regularly.
A meta-analysis showed an effect size (SMD) of 0.67 for the combination of shockwave + PRP, versus 0.48 for shockwave alone. That difference is clinically relevant, although the evidence remains limited.
Curious about the state of your erectile function?
The SHIM test gives a first indication in five questions.