Treatment of Erectile Dysfunction using Stem Cells in Germany

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Erectile dysfunction (impotence) is a disease in which it is impossible to achieve a sufficient erection for sexual intercourse. This pathology can have many reasons. Depending on the origin, erectile dysfunction requires different approaches to treatment. Cellular regenerative medicine has been developing in recent years.  In Germany, stem cells are used to enhance male potency.

Content

1. Types of erectile dysfunction
2. Risk factors
3. Diagnostics of erectile dysfunction in Germany
4. Standard treatment methods of erectile dysfunction (impotence)
5. Disadvantages of standard methods
6. Intracavernous injection of MSCs
7. Stem cells for neurogenic ED in Germany
8. Stem cells for endocrine ED in Germany
9. How to go to Germany for treatment?

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. Treatment tactics depend on the cause of the deterioration of an erection.

The following types of erectile dysfunction are distinguished:

• Psychogenic – associated with psychological factors, this mainly occurs 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 deterioration of their condition due to age-related changes
• Neurogenic – the result of damage to peripheral nerves, most often detected in diabetes mellitus and in men after a prostatectomy
• Endocrine – a group of diseases which lead 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. Doctors usually use a permanent, symptomatic treatment. It is applied on demand and can improve an erection for a short time, which is sufficient for intercourse. Another option is supportive therapy, which slows down the further progression of the pathology. If conservative treatments are unsuccessful, sometimes it is necessary to resort to surgical methods.

Risk factors 

The disease is extremely common among elderly patients. An epidemiological study in Cologne showed that the prevalence of the pathology is 19.2% in men aged 30 to 80 years. However, indicators significantly depended on age. In different categories of men, the incidence of erectile dysfunction ranged from 2.3% to 53.4%.

Thus, age is the main risk factor for this pathology. Here are a few more adverse factors that can increase the risk of the pathology:

• low levels of physical activity;
• smoking;
• obesity;
• hypercholesterolemia.

An MMAS study found that regular exercise and physical activity reduced the risk of erectile dysfunction by 70% over 8 years.

Diagnostics of erectile dysfunction in Germany

For a successful treatment of erectile dysfunction, it is important to determine the cause and mechanisms of the disease. This is the main goal for doctors who are involved in the diagnostic process.

The doctor begins by looking at the patient's medical history. He clarifies all the risk factors that could lead to one or another type of erectile dysfunction.

Vasculogenic ED usually occurs due to arterial hypertension, obesity, smoking, or diabetes mellitus. It is usually identified in older men. It is often combined with ischemic heart disease and atherosclerotic lesions of the vessels of the legs and brain.

Neurogenic ED can be central or peripheral. Central develops due to brain tumors, Parkinson's disease, multiple sclerosis, or spinal hernias in the lumbar region. Peripheral develops against the background of diabetes mellitus, alcoholism, polyneuropathy, or surgery (usually a radical prostatectomy).

Anatomical (penile) ED develops in patients with Peyronie's disease, after a penile fracture or other injuries. The cause of this disease can be congenital pathologies, such as curvature of the penis, hypospadias, epispadias, or micropenis.

Endocrine ED can be caused by any diseases and conditions that lead to a decrease in testosterone levels. It may be primary hypogonadism, caused by damage to the testicles or the result of insufficient or excessive production of other hormones that affect androgen secretion. Possible endocrine causes are hyperprolactinemia, hypothyroidism, or Cushing's disease.

Psychogenic ED can be generalized or situational. In a case of generalized erectile dysfunction, the person is not capable of sexual arousal. Depression or another mental disorder may be the cause. Situational psychogenic ED can be associated with a specific partner or a situation tied to a place or time.

Drug-induced erectile dysfunction is classified separately. This is erectile dysfunction due to various mechanisms, which are caused by drugs. They can affect blood vessels, nerves, and hormone levels, but these are usually temporary side effects that disappear when the drug is stopped. ED is mainly caused by drugs, antiandrogens, antipsychotics, antidepressants, antiallergic (antihistamines) medications, and certain medications for treating hypertension (beta-blockers and potassium-sparing diuretics).

Some diseases can already be detected in the patient upon admission and are recorded in his medical history. There are a number of pathologies that urologists or andrologists can identify straight away during an appointment. The doctor sometimes reveals an enlarged prostate, anatomical anomalies of the penis, small 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 cases of low levels of testosterone
• Blood sugar levels on an empty stomach and lipid profile (cholesterol, triglycerides, lipoproteins of different classes)

Special tests:

Nocturnal swelling and stiffness of the penis. They determine the preservation of the erectile mechanism. The rating is for 2 nights or more. The occurrence 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 bend the penis) should occur in no more than 10 minutes and last for at least 30 minutes. If violations are found, duplex scanning (ultrasound) of the vessels of the penis will be performed.

Ultrasound of the arteries of the penis. Blood pressure of 30 mm Hg is considered the norm, with a resistance index of more than 0.8. With a normal result, vasculogenic (vascular) erectile dysfunction is excluded.

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Standard treatment methods of erectile dysfunction (impotence)

The main directions for the treatment of erectile dysfunction are:

Elimination of the causes of erectile dysfunction. This is possible in a limited number of cases of psychogenic ED, traumatic vascular injury, and some endocrine diseases. In most cases, the disease cannot be completely cured.

Elimination of risk factors. Under their influence, the disease progresses. Patients are advised to make lifestyle changes, such as moving more, losing weight, keeping blood pressure at a normal level with medication, and eating healthy foods. All these measures can improve the condition of blood vessels and normalize metabolic processes and hormone levels.

Symptomatic treatment. Used to achieve an erection just before intercourse. For this, various groups of drugs (most often a type 5 phosphodiesterase inhibitor) and vacuum devices (negative local pressure therapy) can be used.

The treatment process is usually divided into three stages. First line therapy is performed first. At some point, it stops working. Doctors then resort to second-line therapy. When these measures also stop working, only third-line therapy remains, this is surgical.

First-line therapy 

Therapy depends on the type of erectile dysfunction. Psychological impotence is most common in young men. It is treated with psychotherapy, antidepressants, and anxiolytics (relieve anxiety). If the reason is overwork, it is necessary to improve the overall well-being, increase efficiency, normalize weight, etc.

In cases with a development of endocrine erectile dysfunction, the normalization of hormonal balance is required. If the patient has primary testicular hypogonadism, testosterone medications can be prescribed. Decreased testosterone levels can be caused by other endocrine diseases, since hormones regulate androgen production. In this case, doctors may use other drugs, for example, thyroxine for hypothyroidism, bromocriptine for hyperprolactinemia, or hCG for hypogonadotropic hypogonadism.

Regardless of the type of endocrine disorder, taking hormones or their antagonists usually helps to quickly normalize hormonal balance and testosterone levels. These measures can improve erectile function, but the patient is prescribed lifelong hormone therapy.

Vascular ED is the most common type of ED. It is treated with PDE5 inhibitors. These drugs dilate the blood vessels and provide blood flow to the penis. Some medicines last only a few hours, while others last up to 2 days. These are the most common drugs for the treatment of impotence, but they only give a symptomatic effect.

In cases with an injury to the penis, blood vessels can be damaged. In these cases, a traumatic type of vasculogenic ED occurs. It can be cured with surgical revascularization (restoration of blood flow). The efficiency of such operations is about 70%. The operation cannot be performed in cases with veno-occlusive ED, due to unsatisfactory efficacy, and these cases are therefore excluded during the ultrasound examination before treatment.

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Second-line therapy 

Doctors use other oral medications and topical medications. Drugs such as papaverine, nitroglycerin, or minoxidil gel can be prescribed. The composition of these usually includes a vasodilator 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, the patient needs a vacuum device, a so-called pump. The vacuum draws blood and allows the patient to achieve an erection, even without sexual arousal. To prevent its outflow, latex rings are used; they are attached to the base of the penis.

The effectiveness of the procedure is 90%. However, after 2 years, it gradually decreases to 60%. Most men refuse LNP therapy within 3 months after starting it due to insufficient satisfaction with their intimate life: the mechanisms of erection are effective, but not physiological. 30% of patients experience side effects. The ring cannot be used for more than 30 minutes, due to the threat of tissue death, which limits the time of intercourse.

The efficiency of intracavernous injections is 85%. Twenty years ago, this was first line therapy. Alprostadil is used. Although the technique is effective, it has side effects and is therefore not suitable for everyone. 50% of men experience pain at the injection area and 5% have excessively prolonged erections. The risk of scarring of the penis is 2% and the risk of priapism is 1%.

Sometimes, endourethral administration of alprostadil is performed. The positive side of this procedure is obvious. There is no need to inject into the penis, but this procedure has drawbacks. Its efficiency 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 and 5% of patients have urethral bleeding due to improper intake. 30-40% of men experience pain. In addition, the achieved erection does not last long.

Third-line therapy 

The third-line therapy is penile prosthetics. A flexible or inflatable prosthesis can be used. The most natural erection is achieved with a 3-piece prosthesis.

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 - about 1%.

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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, doctors use only symptomatic therapy, the effectiveness of which will gradually decrease.

Each method has its drawbacks. With the prolonged use of drugs, side effects are possible. They can also be caused by topical pump therapy or medication. Some complications are quite serious and require surgery or invasive procedures.

Surgery is the most effective method of obtaining long-term results, but such methods of treatment are not suitable 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 violates the physiology of sexual intercourse. Infectious complications are possible even in the best clinics in 2-3% of patients, and doctors have to reoperate on these patients.

Standard methods may soon be replaced by cellular technology. This is already in use in developed countries. Stem cells have been shown to work well for various types of erectile dysfunction. They repair tissue and improve innervation, blood supply to the penis, and hormone production. These methods are safe and long lasting.

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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 being used to treat diseases such as orthopedic, neurological, gynecological, urological, etc.

Injections of MSCs into the corpus cavernosum 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 goals:

1. Adipose tissue is taken from the anterior abdominal wall using liposuction. The procedure is performed under general or local anesthesia. The adipose tissue is aspirated with a syringe. The resulting tissue volume is about 250 ml.
2. The stromal vascular fraction is derived from adipose tissue. It contains a large number of mesenchymal stem cells. Many methods can be used to obtain a fraction. In some clinics, they are obtained manually by enzymatic methods, in several stages, but in Germany, medical centers that conduct cell therapy have special equipment. They automatically obtain the stromal vascular fraction from adipose tissue. This fraction contains many more stem cells, which allows doctors to provide better erectile dysfunction treatment outcomes.
3. A fraction of the stromal vessels is injected into the intracavernous body at a dose of 4 ml. This number contains an average of 50 million mesenchymal stem cells. The dose is distributed evenly - usually in 6 different points. A tourniquet is used for 15 minutes to restrict the blood flow from the penis and reduce the migration of stem cells from the injection site.

Stem cells stimulate the regeneration of tissues of the penis, blood vessels, and nerves. They have long-term therapeutic, but not palliative or symptomatic, effects. After a course of therapy in Germany, the patient can expect their erection to last a long time. If necessary, the course of treatment can be repeated after several years. This procedure is an alternative to surgical intervention in cases where erectile dysfunction is not amenable to pharmacological correction or other conservative treatment methods.

Oleg, 59 years old. After the stem cell injections, I felt a slight burning sensation for several days. There was swelling, but it did not cause severe discomfort. A few weeks later, I felt a second youth! In the best case, before an erection occurred once in three, but now the wife is completely satisfied. Previously, I only had Viagra in my arsenal, but recently it stopped working. This prompted me to travel to Germany for diagnosis and treatment. Thanks to Booking Health for the whole organization. I was placed in a good clinic and saved about 30% on medical procedures.

Stem cells for neurogenic ED in Germany

One of the common problems in older men is trauma and degeneration of the nerves of the pelvis and penis. Neurogenic erectile dysfunction is most commonly caused by diabetes. This also happens after a prostatectomy.

Treating neurogenic erectile dysfunction is very difficult. In fact, there are no effective drugs for restoring an erection with nerve damage. Viagra or other PDE5 inhibitors can be used for vascular erectile dysfunction. Testosterone preparations can be used for endocrine ED, but there is nothing doctors can do about nerve damage.

However, stem cell injections are showing promising results. They are injected both directly into the corpora cavernosa and intravenously. A similar effect can be achieved in the second case, but this will require a larger number of stem cells. Therefore, intracavernous injections are performed more often.

Clinical trials show excellent treatment results. Complete regeneration of the cavernous nerves occurs under the action of stem cells. At the same time, the use of cellular technologies is completely safe. No complications or clinically significant side effects have been identified in clinical trials. The treatment works well and is well tolerated by patients.

The period of time that 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 by which an erection is assessed. After the introduction of stem cells, the average score on the IIEF-5 scale by the end of the 3rd month increases from 6-8 to 24-25 points. The strength of erection on the Unem scale increases from ER3 to ER5. Electromyographic data of the corpus cavernosum of the penis show a positive dynamic.

In recent years, more and more research has been carried out. These investigations are aimed at studying the effect of stem cells on erection. More and more clinics in developed countries are introducing this technique into medical practice. Today, you can take advantage of the advances in cell therapy. To do this, you can visit one of the German clinics that practice this method of treating erectile dysfunction.

This method has the following advantages:

• The patient is injected with autologous cells, not allogeneic, which makes the procedure safe.
• Long-term results, not symptomatic as is the case with 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 apparent 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 possibilities of standard conservative therapy have already been exhausted. In this case, the patient wants to restore a full intimate life and at the same time, wants to avoid surgery (phallus prosthetics).

Valery, 35 years old. My diabetes began to cause complications. The disease was diagnosed at an advanced stage, so I did not receive treatment for a long time. As a result, my erection almost completely disappeared. For some time, it was possible to maintain it with the help of medications prescribed by the doctor. After about 2 years, they stopped working. I have no financial problems, so I went to Germany for treatment. I was offered phallus prosthetics, because the tests showed that it was unlikely to be possible to restore an erection with the help of drugs. I refused the operation. Then the doctors suggested an alternative - stem cells - and it worked! I first pleased my wife a month after the procedure. After 3 months, my "tool" started working without "failures", the procedure was carried out 2.5 years ago, so far, everything is in order.

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Stem cells for endocrine ED in Germany

Endocrine erectile dysfunction is caused by low testosterone levels. The patient can constantly receive injections of this hormone, but with the help of stem cells, its endogenous formation can be enhanced - this method of treatment is more physiological and does not require constant medical support.

With age, the production of pluripotent stem cells decreases in humans, so tissues are renewed less intensively. Gradually, testicular sclerosis occurs - the number of Leydig cells responsible for testosterone levels decreases by 1% annually. Androgen production also decreases by about 1% annually. With a lack of male hormones, libido decreases and erectile dysfunction occurs.

Pluripotent stem cells can be obtained from a donor. They can be administered intravenously at intervals of 2-3 months. With this procedure, you can dramatically increase the level of testosterone in the blood of patients that are 50-60 years old. Gradually, he will reach the level of youth. The results last for a long time, as the procedure does not cause temporary overproduction of androgens, but increases the number of Leydig cells in the testes.

Konstantin, 62 years old.  For a long time, I noticed that my erection and desire had weakened. I went to the doctor and he prescribed testosterone shots for me. I have had this treatment for about 3 years and it has worked. I was recently in Germany for another illness. When it came to my problem, the doctor offered to use stem cells for a long-term solution for me. After several intravenous infusions, I did not feel any changes. However, I have not taken testosterone again and my erection remains excellent, despite not receiving hormone injections for over 2 years! I recently had diagnostic tests, and the doctors at the clinic said that my testosterone levels were about the same as a 40-year-old man.

The number of people treated for erectile dysfunction with stem cells is now in the thousands. Doctors have not recorded a single case of severe complications. This procedure is safe, effective, and provides long-term results by stimulating tissue regeneration.

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How to go to Germany for treatment? 

Previously, it was rather difficult to go to Germany for treatment, since you had to look for a clinic yourself, contact its administration, wait for an invitation for treatment, translate documentation, and look for an interpreter for oral communication. A person had to spend a huge amount of time, effort, and money on organizing a trip, but this is no longer required, since Booking Health can take over all the organizational issues. You can use our service for the selection of a clinic. If necessary, our specialists will help you choose the best center that specializes in the treatment of erectile dysfunction using stem cells. There, you will undergo diagnostics and therapy that will bring you the best results. In particular, many men receive treatment at the Clinic of Advanced Biological Medicine Frankfurt-am-Main. The clinic's specialists determine the cause of erectile dysfunction and carry out all stages of stem cell therapy – stimulation aimed at increasing the number of multipotent stem cells in the organism, harvesting and cultivating stem cells, replantation of stem cells into the body, and supportive fluid therapy. In most cases, one visit to the clinic is enough to achieve the desired result. The cost of stem cell treatment for erectile dysfunction in the Department of Alternative Medicine starts from €17,100.

The Booking Health company provides the following benefits:

• We will help you choose a clinic based on statistics, equipment, specialization, experience, and results of stem cell therapy.
• The average cost of treatment for you will be much lower, due to the absence of overpricing and additional coefficients for foreign patients.
• We will shorten your waiting time for the start of treatment and book an appointment on convenient dates for you.
• We will arrange your communication with the doctor at the end of the treatment program.
• We will prepare and supervise your medical program.
• We will monitor the billing, the volume of services provided, and will refund any unspent funds at the end of your treatment program.
• We arrange insurance for you against an increase in the cost of treatment, in case of complications (coverage of €200,000, valid for 4 years).
• We will buy and send the medicines prescribed by your doctor from Germany.
• If necessary, we will organize additional examinations, treatment, and rehabilitation in German clinics.
• We will provide communication with the medical center upon the completion of your medical program.

We will solve all your travel issues, book your flights and hotel, meet you at the airport in Germany, and take you to a clinic or hotel. At the end of your course of treatment, we will take you back to the airport.

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Authors:

The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk, Dr. Nadezhda Ivanisova. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

MedlinePlus

Centers for Disease Control and Prevention

PubMed

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