I Nengah Raka Swastika, I Gusti Ngurah Pramesemara

Injeksi sekretom sel punca mesenkimal pada penis pasien disfungsi ereksi di Denpasar, Bali: laporan kasus

Introduction

Injeksi sekretom sel punca mesenkimal pada penis pasien disfungsi ereksi di denpasar, bali: laporan kasus. Laporan kasus injeksi sekretom sel punca mesenkimal untuk disfungsi ereksi kronis di Denpasar, Bali. Menunjukkan perbaikan signifikan pada pasien dengan komorbiditas. Terapi inovatif menjanjikan.

Abstract

Background: Erectile dysfunction (ED) is a common condition in aging males and often associated with comorbidities such as diabetes mellitus, hypertension, and dyslipidemia. While phosphodiesterase type-5 (PDE5) inhibitors remain first-line therapy, their effects are limited in some patients, prompting interest in minimally invasive options such as mesenchymal stem cell–derived secretome (MSC-secretome). This case report aims to evaluate the effect of intracavernosal mesenchymal stem cell–derived secretome injection in a patient with erectile dysfunction in Denpasar, Bali. Case Presentation: A 60-year-old male presented with a 10-year history of persistent ED. He reported difficulty in both achieving and maintaining penile erection, resulting in unsatisfactory sexual activity. Medical history included hypogonadism, diabetes mellitus, hypertension, and dyslipidemia, all of which are recognized risk factors for ED. Baseline evaluation showed an International Index of Erectile Function-5 (IIEF-5) score of 10 and an Erection Hardness Score (EHS) of 2, consistent with moderate to severe ED. Physical examination revealed reduced secondary sexual characteristics, and laboratory testing indicated low serum testosterone.The patient underwent multimodal therapy, consisting of intracavernosal MSC-secretome injection, intramuscular testosterone undecanoate, and daily oral tadalafil combined with Tribulus terrestris. Follow-up after the intervention demonstrated a marked improvement: IIEF-5 score increased to 20 and EHS improved to 4, with the patient reporting satisfactory erectile function and enhanced quality of life. Conclusion: MSC-secretome injection, when combined with hormonal replacement and oral therapy, may provide significant benefits in patients with long-standing ED and multiple comorbidities, supporting its potential as a promising minimally invasive therapeutic strategy. Latar Belakang: Disfungsi ereksi (DE) merupakan gangguan yang sering ditemukan pada pria usia lanjut dan kerap berkaitan dengan penyakit penyerta seperti diabetes melitus, hipertensi, dan dislipidemia. Meskipun inhibitor fosfodiesterase tipe-5 (PDE5 inhibitor) masih menjadi terapi lini pertama, efektivitasnya terbatas pada sebagian pasien, sehingga memunculkan minat terhadap terapi minimal invasif seperti sekretom sel punca mesenkimal (SPM). Laporan kasus ini bertujuan untuk mengevaluasi efek injeksi sekretom sel punca mesenkimal pada penis pasien disfungsi ereksi di Denpasar, Bali. Presentasi Kasus: Seorang pria berusia 60 tahun datang dengan keluhan tidak mampu mencapai dan mempertahankan ereksi selama lebih dari 10 tahun. Aktivitas seksual menjadi tidak memuaskan dan mengganggu kualitas hidup pasien. Riwayat medis meliputi hipogonadisme, diabetes melitus, hipertensi, dan dislipidemia yang merupakan faktor risiko utama DE. Pada penilaian awal, skor International Index of Erectile Function-5 (IIEF-5) tercatat 10 dan Erection Hardness Score (EHS) sebesar 2, sesuai dengan DE derajat sedang-berat. Pemeriksaan fisik menunjukkan tanda sekunder androgen yang menurun, sementara pemeriksaan laboratorium menemukan kadar testosteron rendah.Pasien kemudian diberikan terapi multimodal berupa injeksi sekretom SPM intrakavernosal, testosterone undecanoate intramuskular, serta terapi harian tadalafil oral dikombinasikan dengan Tribulus terrestris. Evaluasi pasca terapi menunjukkan peningkatan signifikan: skor IIEF-5 meningkat menjadi 20 dan EHS mencapai 4. Pasien melaporkan fungsi ereksi yang memadai serta perbaikan kepuasan seksual dan kualitas hidup. Kesimpulan: Injeksi sekretom sel punca mesenkimal, terutama bila dikombinasikan dengan terapi hormonal dan oral, berpotensi memberikan manfaat bermakna pada pasien dengan DE kronis dan komorbiditas multipel, sehingga layak dipertimbangkan sebagai modalitas terapi minimal invasif yang menjanjikan.

Review

This case report addresses a significant clinical challenge in the management of erectile dysfunction (ED), particularly in patients with complex comorbidities where conventional treatments often fall short. The authors present an intriguing case of a 60-year-old male with a 10-year history of severe ED, complicated by hypogonadism, diabetes, hypertension, and dyslipidemia, who experienced a remarkable improvement in erectile function and quality of life following a multimodal therapeutic intervention. The reported success, particularly the notable increase in IIEF-5 and EHS scores, positions mesenchymal stem cell-derived secretome (MSC-secretome) as a potentially promising component of a comprehensive strategy for refractory ED. However, the interpretation of these findings must be approached with caution due to several inherent limitations. As a single case report, the ability to establish causality or generalize these positive outcomes is severely restricted. The patient received a complex combination therapy involving intracavernosal MSC-secretome injection, intramuscular testosterone undecanoate, daily oral tadalafil, and *Tribulus terrestris*. This multimodal approach makes it impossible to discern the independent contribution of the MSC-secretome, or indeed any single component, to the observed improvements. Furthermore, critical details regarding the MSC-secretome, such as its source, preparation methods, purity, concentration, and the precise number of injections, are not provided, which significantly hinders reproducibility and the scientific rigor of the report. The duration of follow-up also appears to be limited, necessitating longer-term data to assess the sustainability of the response and any delayed adverse events. Despite these caveats, this report serves as a valuable initial communication, highlighting a potential synergistic benefit of combined therapies in challenging ED cases and generating a compelling hypothesis for future research. It underscores the potential of MSC-secretome as an innovative treatment modality, warranting further rigorous investigation. Future studies should prioritize well-designed, controlled clinical trials that isolate the effects of MSC-secretome, optimize its dosage and delivery, and meticulously document its safety and long-term efficacy in a larger, more diverse patient population. This exploratory work provides a crucial stepping stone towards understanding the true therapeutic potential of MSC-secretome in ED.

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