Therapeutic Effects of Intracavernosal Stromal Vascular Fraction in an Ischemic Cavernosal Injury Model of Erectile Dysfunction

Purpose To evaluate the effects of intracavernosal stromal vascular fraction (SVF) on erectile function and tissue-level changes in an ischemic priapism model. Methods Male Wistar rats (n=24) were randomized to Sham, Priapism, or Priapism+SVF (n=8 each). Priapism was induced with a penile base constrictor for 60 min. Autologous SVF from peritesticular fat was injected at band removal. At 4 weeks, cavernous nerve–stimulated intracavernosal pressure (ICP) and mean arterial pressure (MAP) were recorded; penile tissue underwent histology, immunohistochemistry, and qRT-PCR. Results Two rats died before model creation; analyses included Sham (n=8), Priapism (n=7), and Priapism+SVF (n=7). Baseline ICP and MAP were similar (p=0.105; p=0.911). Priapism lowered ICPmax, ICPmean, and ICP/MAP versus Sham (all p<0.001). SVF improved ICPmax and ICP/MAP versus Priapism (p=0.002; p=0.013) but did not reach Sham. ICPmean difference was not significant between Priapism and SVF groups (p=0.079). qRT-PCR showed no differences in NGF, TGF-β1, VEGF, or BDNF (all p>0.05). Histology showed more inflammation, fibrosis, cellular injury, hypoplasia, and loss of elastin in Priapism; with SVF these changes shifted to milder grades and elastin partially recovered (all p=0.001). Immunohistochemistry: VEGF unchanged; Bcl-2 higher in Priapism and intermediate after SVF (extent p=0.035; intensity p=0.001). eNOS reduced in Priapism and partially restored with SVF (extent p=0.006). nNOS elevated in Priapism and attenuated with SVF (both p=0.001). iNOS remained higher in both Priapism arms compared to Sham (both p=0.003). The muscle-to-fibrosis ratio did not differ (p=0.561), whereas the type I/type III collagen ratio did (p=0.003). Conclusions Intracavernosal SVF conferred partial protection in ischemic priapism. Its minimally processed, point-of-care profile supports feasibility after detumescence, and its endothelial, antifibrotic, and neurotrophic actions make it promising for broader erectile dysfunction phenotypes. Larger preclinical and controlled clinical studies should define optimal dose/timing and establish long-term efficacy and safety.