Umbilical Cord Mesenchymal Stem Cell Secretome Administration in Severe Erectile Dysfunction Non-responsive to Sildenafil

Inclusion Criteria: * Men aged 40-65 years who undergo treatment at the Andrology Clinic of RSUD Dr. Soetomo. * Severe erectile dysfunction caused by organic factors for at least 6 months, based on an IIEF-5 score of 5-7 * History of undergoing treatment with sildenafil 100 mg for four sessions. * Evaluation of IIEF-5 score \< 22 and not meeting the MCID criteria, defined as an IIEF-5 score increase of less than 4 * Type II Diabetes Melitus with an HbA1c test result of \< 7%. * Laboratory test results for liver function (SGOT and SGPT) and kidney function (urea and creatinine) are within normal limits. * Patients with undergoing treatment with antidepressant. Exclusion Criteria: * Anatomical abnormalities of the penis that are clinically visible, such as Peyronie's disease, a history of priapism, a history of penile implants, skin irritation, and lesions in the area surrounding the penile skin. * Active and significant systemic or local infection. * History of bleeding or blood clotting disorder therapy. * History of systemic autoimmune disorders and immunosuppressive treatment * History of prostate surgery, history of malignancy, or a PSA level \> 4 ng/mL. * Untreated hypogonadism or low serum total testosterone (\<200 ng/dL). * Uncontrolled hypertension or hypotension (systolic blood pressure \>170 or \<90 mmHg, and diastolic blood pressure \>100 or \<50 mmHg). * Unstable cardiovascular disease (e.g., unstable angina, myocardial infarction within the last 6 months, and c…