Erectile dysfunction (impotence) is a disease, which makes it impossible to achieve a sufficient erection for sexual intercourse. This pathology can have many causes. Depending on the origin, erectile dysfunction requires different treatment approaches. In recent years, cell regenerative medicine has been developing. In Germany, stem cells are used to improve male potency.
Types of erectile dysfunction
There are many classifications of erectile dysfunction. The most important is the etiological classification, which divides this disease into groups, depending on the cause. The treatment approach depends on the cause of the deterioration of erection.
The following types of erectile dysfunction are distinguished:
- Psychogenic – associated with psychological factors, it occurs mainly in young men
- Organic – often occurs in old age, it is associated with anatomical and functional disorders in the body
Organic erectile dysfunction has the following types:
- Vasculogenic or vascular – caused by damage to blood vessels or worsening of their state due to age-related changes
- Neurogenic – the result of peripheral nerve injury, most often detected in diabetes mellitus and in men after prostatectomy
- Endocrine – a group of diseases, which leads to a decrease in testosterone production
- Penile – associated with penile diseases (the most common cause is Peyronie's disease)
Organic erectile dysfunction can rarely be cured once and for all. The doctors mostly use constant symptomatic treatment. It is applied on demand and can improve erection for a short time, which is sufficient for sexual intercourse. Another option is supportive therapy, which slows down the further progression of the pathology. If conservative treatments do not lead to success, it is sometimes necessary to resort to surgical techniques.
The disease is extremely common among elderly patients. An epidemiological study in Cologne showed that the prevalence of pathology is 19.2% in men aged between 30 and 80 years. However, the indicators depend significantly on age. In different categories of men, the occurrence of erectile dysfunction ranged from 2.3% to 53.4%.
Thus, the main risk factor for pathology is age. Here are some other adverse factors, which can increase the risk of occurrence of the pathology:
- Low levels of physical activity
The MMAS study showed that regular exercise and physical activity reduce the risk of erectile dysfunction by 70% within 8 years.
For the successful treatment of erectile dysfunction, it is important to determine the cause and mechanisms of this disease. This is the main purpose of doctors who are involved in the diagnostic process.
The doctor begins with the study of a medical history and the patient's medical records. He clarifies all risk factors, which can lead to one or another type of erectile dysfunction.
Vasculogenic ED usually occurs due to arterial hypertension, obesity, smoking, diabetes mellitus. It occurs mainly in older men. It is often combined with coronary artery disease, atherosclerotic lesions of blood vessels in the legs and brain.
Neurogenic ED can be central and peripheral. The central one develops due to the brain tumors, Parkinson's disease, multiple sclerosis, cerebrospinal hernias in the lumbar region. The peripheral one develops due to diabetes mellitus, alcoholism, polyneuropathy, surgery (usually radical prostatectomy).
Anatomical (penile) ED develops in patients with Peyronie's disease, after a penile fracture or other injuries. Such congenital pathologies as penile curvature, hypospadias, epispadias, micropenis can be the cause of this disease.
Endocrine ED can be caused by any diseases and conditions, which lead to the decreased testosterone levels. It may be the primary hypogonadism caused by testicular lesions, or the result of insufficient or excess production of other hormones affecting the secretion of androgens. Such endocrine causes as hyperprolactinemia, hypothyroidism, Cushing's disease are possible.
Psychogenic ED can be generalized or situational. In the case of generalized erectile dysfunction, the person is incapable of sexual arousal. The cause may be a depression or another mental disorder. Situational psychogenic ED can be associated with a particular partner, situation, attached to a place or time.
Erectile dysfunction caused by medications is classified separately. This is an erectile dysfunction on various mechanisms, which is caused by drugs. They can affect blood vessels, nerves, hormone levels, but usually these are temporary side effects, which disappear after drug withdrawal. ED is mostly caused by narcotic drugs, antiandrogens, antipsychotics, antidepressants, antiallergic (antihistamines) drugs and some drugs for hypertension treatment (beta-blockers and potassium-sparing diuretics).
Some diseases may already be detected in the patient during the admission and recorded in his medical history. A number of pathologies can be detected by urologist or andrologist directly during the appointment. The doctor sometimes reveals an enlarged prostate, anatomical penile abnormalities, small size of the testicles, etc.
Here are the basic laboratory tests, which aim to detect the cause of erectile dysfunction:
- Determination of total testosterone in the morning blood
- FSH, LH, prolactin, thyroid hormone testing – in the case of low levels of testosterone
- Blood sugar levels on an empty stomach and lipid profile (cholesterol, triglycerides, lipoproteins of different classes)
Nocturnal penile tumescence and rigidity. These determine the preservation of the erectile mechanism. The assessment is carried out for 2 nights or more. The onset of spontaneous nocturnal erections up to 60% for at least 10 minutes indicates the preservation of the erectile mechanism.
Intracavernous injection test. After the injection of antispasmodics into the penis, a hard erection (inability to flex the penis) should occur no more than 10 minutes later and last no less than 30 minutes. Should violations be detected, a duplex scan (ultrasound) of the penile vessels will be carried out.
Ultrasound of the penile arteries. The norm is considered to be blood pressure in them from 30 mm Hg, while the resistance index should be more than 0.8. If the result is normal, the vasculogenic (vascular) erectile dysfunction is excluded.
Standard ED treatment methods
The main directions for the treatment of erectile dysfunction are:
Elimination of the causes of erectile dysfunction. It is possible in a limited number of cases, in psychogenic ED, traumatic vascular injury and some endocrine diseases. Most cases of the disease cannot be completely cured.
Elimination of risk factors. The disease progresses under their influence. The patients are recommended lifestyle modification, for example, to move more, to lose weight, to keep blood pressure at normal levels with the help of drugs, to eat healthy food. All these measures can improve the state of blood vessels, normalize metabolic processes and hormone levels.
Symptomatic treatment. It is used for the achievement of erection just before sexual intercourse. For this purpose, various groups of drugs can be used (most often phosphodiesterase type 5 inhibitor) and vacuum devices (negative local pressure therapy).
The treatment process is usually divided into three stages. Initially, the first-line therapy is carried out. At some stage, it stops working. Then the doctors resort to the second-line therapy. When these measures also stop working, only the third-line therapy remains, which is the surgical one.
The therapy depends on the type of erectile dysfunction. The psychological impotence is most common in young men. It is treated by means of psychotherapy, antidepressants, anxiolytics (relieve anxiety). If the cause is fatigue, it is necessary to improve general state of health, increase working capacity, normalize weight, etc.
In the case of development of endocrine erectile dysfunction, the normalization of a hormonal balance is required. If the patient has primary hypogonadism caused by testicular lesions, he can be prescribed testosterone medications. The decreased testosterone levels can be caused by other endocrine diseases, since many hormones regulate androgen production. In this case, the doctors can apply other means, for example, thyroxine in the case of hypothyroidism, bromocriptine in the case of hyperprolactinemia or HCG in the case of hypogonadotropic hypogonadism. Regardless of the type of endocrine disorder, the intake of hormones or their antagonists usually helps to quickly normalize the hormonal balance and testosterone levels. These measures can improve the erectile function, but the patient is prescribed lifelong hormone therapy.
Vascular ED is the most common type. It is treated by means of PDE5 inhibitors. These drugs dilate blood vessels and provide blood flow to the penis. Some medications act only a few hours, while others work up to 2 days. These are the most common medications for the treatment of impotence, but they provide only a symptomatic effect.
In the case of penile injury, blood vessels may be damaged. In this case, a traumatic type of vasculogenic ED occurs. It can be cured during surgical revascularization (restoration of blood flow). The efficiency of such operations is about 70%. The operation cannot be carried out in veno-occlusive ED because of unsatisfactory effectiveness, and therefore it is excluded by means of ultrasound examination prior to the treatment.
The doctors use other oral medications and local drug therapy. Such drugs as papaverine, nitroglycerin or minoxidine gel can be locally prescribed. The composition usually includes a vasodilator component in order to improve the absorption of active substances. The effectiveness of these drugs is low – about 40%.
LNP therapy involves the use of local negative pressure. For this purpose, the patient needs a vacuum device, the so-called pump. The vacuum draws blood and allows the patient to achieve an erection even without sexual arousal. To prevent its outflow, the latex rings are applied, they are attached to the base of the penis.
The effectiveness of the procedure is 90%. However, 2 years later, it gradually decreases to 60%. Most men refuse LNP therapy within 3 months after its initiation due to the insufficient satisfaction with their intimate lives: the mechanisms of erection are effective, but not physiological. 30% of patients experience side effects. The ring can not be used for more than 30 minutes in a row due to the threat of tissue death, which limits the time of sexual intercourse.
Intracavernous injections have an effectiveness of 85%. Twenty years ago it was first-line therapy. Alprostadil is applied. Although the technique is effective, it causes side effects, so it is not suitable for everyone. 50% of men have pain at the injection area, 5% have an excessively long erection. The risk of cicatricial changes in the penis is 2%, whereas the risk of priapism occurrence is 1%.
Endourethral administration of alprostadil is sometimes carried out. The positive side of this procedure is obvious. There is no need to perform an injection into the penis, but this procedure also has disadvantages. Its effectiveness is only 30-65%. Only high doses of the drug work, but they often cause systemic side effects. Up to 14% of patients complain of dizziness, while 5% of patients have urethral hemorrhages due to improper administration. 30-40% of men experience pain. In addition, the achieved erection does not last long.
The third-line therapy is penile prosthetics. Flexible or inflatable prostheses canbe used. The most natural erection is achieved using three-component prostheses.
The following complications are possible:
- About 5% of prostheses break down within 5 years
- The risk of infectious complications in the best clinics is 2-3%, and in the case of implantation of prostheses with antibiotics it is about 1%
Disadvantages of standard methods
The standard treatment for erectile dysfunction has several disadvantages. It is not always effective and often dangerous. Only a small number of cases can be cured. In other cases, the doctors use only symptomatic therapy, the effectiveness of which will be gradually reduced.
Each method has its disadvantages. With the prolonged use of drugs, side effects are possible. They can also be caused by local therapy with a pump or drugs. Some complications are quite severe and requirу surgical treatment or invasive procedures.
Surgery is the most effective method for obtaining a long-term result, but such treatment method is not acceptable for all men. It carries certain risks, namely, the aesthetic result is not always satisfactory, and the achieved erection is not caused by sexual arousal – this impairs the physiology of sexual intercourse. The infectious complications are possible even in the best clinics in 2-3% of patients, so they have to undergo a second operation.
The standard techniques may soon be replaced by cellular technology. They are already used in developed countries. Stem cells provide good results for various types of erectile dysfunction. They restore tissue, improve innervation, blood supply to the penis and hormone production. These methods are safe and ensure long-lasting results.
Intracavernous injection of MSCs
Mesenchymal stem cells (MSCs) can be obtained from adipose tissue. It contains much more of these cells than peripheral blood or bone marrow. MSCs are increasingly applied for the treatment of such conditions as orthopedic, neurological, gynecological, urological diseases, etc.
The injections of MSCs into the cavernous bodies of the penis can improve the blood supply to this organ and its innervation. This approach is effective for penile, vasculogenic and neurogenic erectile dysfunction. This method has the following purposes:
- Adipose tissue is taken from the anterior abdominal wall using liposuction. The procedure is performed under general or local anesthesia. Adipose tissue is sucked off using syringe. The volume of tissue obtained is about 250 ml.
- Stromal vascular fraction is obtained from adipose tissue. It contains a large number of mesenchymal stem cells. Many methods can be used in order to obtain the fraction. In some clinics, they are obtained manually using enzyme methods, in several stages, but in Germany, medical centers, which carry out cell therapy, have special equipment. They obtain the stromal vascular fraction from adipose tissue automatically. Such a fraction contains much more stem cells, which allows the doctors to provide better treatment results for erectile dysfunction.
- Stromal vascular fraction is injected into the intracavernous body at a dose of 4 ml. This amount contains 50 million mesenchymal stem cells on average. The dose is evenly distributed – it is usually injected into 6 different points. A tourniquet is used for 15 minutes in order to limit blood flow from the penis and reduce stem cell migration from the injection area.
Stem cells stimulate the restoration of penile tissues, blood vessels and nerves. They have a long-term therapeutic, but not palliative or symptomatic effect. After a course of therapy in Germany, the patient can expect that the erection will last for a long time. If necessary, the treatment can be repeated in a few years. This procedure is an alternative to surgery in the cases when erectile dysfunction is not amenable to pharmacological correction or other conservative treatment methods.
Oleg, 59 years old. After stem cell injections, I felt a slight burning sensation for several days. There was swelling, but it did not cause severe discomfort. In a few weeks I felt a second youth! In the best case, the erection previously occurred one time out of three, but now my wife is completely satisfied. Previously, only Viagra was in my arsenal, but recently it stopped working. This motivated me to go to Germany for the diagnostics and treatment. Thank you Booking Health for organizing everything. I was admitted to a good clinic and saved about 30% on the costs of medical procedures.
Stem cells for neurogenic ED
One of the common problems in older men is trauma and degeneration of nerves of the pelvis and penis. Neurogenic erectile dysfunction is mostly caused by diabetes mellitus. It also occurs after prostatectomy.
It is very difficult to treat neurogenic erectile dysfunction. In fact, there are no effective drugs for the restoration of erection in the case of nerve injury. Viagra or other PDE5 inhibitors can be used for vascular erectile dysfunction, the testosterone drugs can be applied for endocrine ED, but the doctors can do nothing with nerve injury.
However, stem cell injections show the encouraging results. They are injected both directly into the cavernous bodies and intravenously. A similar effect could be achieved in the second case, however, it would demand a greater number of stem cells. Therefore, intracavernous injection is more often carried out.
The clinical trials demonstrate excellent treatment results. The complete regeneration of cavernous nerves occurs under the influence of stem cells. At the same time, the use of cell technologies is completely safe. The complications or clinically significant side effects were not detected during the clinical trials. The treatment works well and is perfectly tolerated by patients.
The period of time, which is required for the restoration of erection:
- The intermediate results can be felt at the end of the first month after stem cell injections
- The significant results can be achieved in a month and a half
- The best results in most trials developed 3 months after the procedure
There are various scales, which serve to assess erection. After the injection of stem cells, the average score on the IIEF-5 scale by the end of 3rd months increases from 6-8 to 24-25 points. The strength of erection according to the Unem Scale increases from ER3 to ER5. Electromyographic data of the cavernous body of the penis show positive dynamics.
In recent years, more and more researches have been carried out. They are aimed at the study of stem cell influence on erection. More and more clinics in developed countries implement this technique into medical practice. Today, you can take advantage of the achievements in the field of cell therapy. For this purpose, you just need to visit one of the German clinics practicing this technique for the treatment of erectile dysfunction.
This method has the following advantages:
- The autologous cells, but not the allogeneic ones are injected to the patient, which makes the procedure safe
- The long-term results, but not the symptomatic one, as in the use of drugs
- The treatment method is minimally invasive and well tolerated by the patient
The disadvantages of the method include:
- High cost in comparison with other conservative treatment methods
- Delayed effect – the first result will be in 1-1.5 months, and the maximum result will be achieved in 3 months
The use of stem cells is usually recommended when the options of standard conservative therapy are already exhausted. In this case, the patient wants to restore the full intimate life and at the same time wants to avoid surgery (falloprosthetics).
Valery, 35 years old. My diabetes mellitus started to cause complications. The disease was diagnosed at the advanced stage, so I did not receive treatment for a long time. As a result, I almost completely lost my erection. For some time, it was possible to maintain it with the help of drugs, which were prescribed by the doctor. After about 2 years, they stopped working. I have no problems with finances, so I went to Germany for treatment. I was offered falloprosthetics, because tests showed that it is unlikely to restore my erection with the help of drugs. I refused the operation. Then the doctors offered me an alternative option, namely, stem cells, and it worked! For the first time I pleased my wife in a month after the procedure. 3 months after, my "instrument" began to work without "failures". The procedure was carried out 2.5 years ago, and so far my erection is fine.
Stem cells for endocrine ED
Endocrine erectile dysfunction is caused by the decreased testosterone levels. The patient can constantly receive injections of this hormone, but with the help of stem cells, it is possible to increase its endogenous formation – this treatment method is more physiological and does not require constant medical support.
With age, the production of pluripotent stem cells decreases in man, so the tissues can be renewed less intensively. Testicular sclerosis gradually occurs – the number of Leydig cells, which are responsible for testosterone levels, decreases annually by 1%. The production of androgens also decreases approximately by 1% annually. With the lack of male hormones, sexual desire decreases and erectile dysfunction occurs.
Pluripotent stem cells can be obtained from a donor. They can be injected intravenously at intervals of 2-3 months. It is possible to sharply increase the testosterone levels in the blood of 50-60-year-old patients by means of this procedure. It gradually reaches the levels of young men. The results persist for a long time, since the procedure does not cause temporary overproduction of androgens, but it increases the number of Leydig cells in the testes.
Konstantin, 62 years old. For a long time I began to notice that erection and desire weakened. I went to the doctor and he prescribed me testosterone injections. I received this treatment for about 3 years, and it worked. Recently, I was in Germany for another disease. When it came to my problem, the doctor offered me to use stem cells for a long-term solution. After several intravenous infusions, I did not feel any changes. However, I no longer received testosterone medications, and my erection remains excellent, despite the fact that I did not receive injections of hormones for more than 2 years! Recently, I had diagnostic tests and the doctors in the clinic said that my testosterone levels are approximately the same as in a 40-year-old man.
The number of people who underwent the treatment of erectile dysfunction by means of stem cells is now in the thousands. The doctors did not recorded a single case of severe complications. This procedure is safe, effective and ensures long-term results by stimulating tissue regeneration.
How to go to Germany for treatment?
It used to be quite difficult to go to Germany for treatment, since you had to look for the clinic yourself, contact its administration, wait for invitation for treatment, translate the documentation, look for an interpreter for oral communication. A person had to spend a huge amount of time, effort and money for the organization of a trip, but this is no longer required, since the Booking Health company can take care of all organizational issues. You can use our service for the selection of the clinic. If necessary, our experts will help you to choose the best center, which specializes in the treatment of erectile dysfunction using stem cells. There you will undergo the diagnostics and therapy, which will bring the best results.
The Booking Health company provides the following benefits:
- We will help you to select the clinic according to statistics, equipment, specialization, experience and the results of stem cell therapy.
- The cost of medical services for you will be much lower due to the lack of overpricing and additional coefficients for foreign patients.
- We will reduce waiting time for the beginning of your treatment and book the appointment on the convenient dates.
- We will arrange your communication with the doctor upon treatment completion.
- We will prepare and control the medical program.
- We will control the invoices, the volume of services provided, and return all unspent funds upon the treatment program completion.
- Insurance against an increase in the cost of treatment in the case of complications (coverage of 200,000 euro, the insurance will be valid for 4 years).
- We will buy and send medicines prescribed by your doctor from Germany.
- If necessary, we will organize additional examination, treatment and rehabilitation in German clinics.
- We will provide communication with the medical center upon the medical program completion.
We will solve all your travel issues, book airline tickets and a hotel, meet you at the German airport and take you to the clinic or hotel. Upon the treatment course completion, we will take you back to the airport.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Vadim Zhiliuk