Treatment of Erectile Dysfunction
Best hospitals and doctors for erectile dysfunction treatment abroad
Leading hospitals
Cost for treatment
Erectile dysfunction is the inability to achieve an erection, which is necessary for full-fledged sexual intercourse. It can be associated with different causes, but most often it is the result of damage to the blood vessels. Doctors in developed countries use not only standard, but also innovative treatments for this pathology, including stem cells, endovascular procedures and surgery to restore blood supply to the penis.
Content
Prevalence
Erectile dysfunction is one of the most common reasons for visiting a urologist. Poor sexual health with erectile dysfunction does not affect life expectancy, but significantly reduces its quality.
Pathology can develop at any age. Erectile dysfunction is determined in 13% of men already in the third decade of their life. After the age of 70 years, 100% of people have poor sexual health, and erectile dysfunction combines several mechanisms of its development at once: the most common of them are damage to the blood vessels and low levels of male hormones.
According to the WHO, 10% of men in the world suffer from impotence. Another 70% periodically experience erection problems. Only 20% of men on the planet have perfect sexual health.
Causes
With erectile dysfunction, the filling of the penis with blood worsens. The causes can be different, and there are 5 main types of pathology distinguished by its origin:
- Psychogenic – caused by an emotional state or mental disorders (the problem primarily affects young men, who usually do not have problems with the health of internal organs).
- Vasculogenic (vascular) – the most common cause associated with impaired blood flow to the penis or increased blood outflow from the corpus cavernosum (a problem of older men with weakened vascular health and high blood pressure).
- Neurogenic – most often develops in diabetes mellitus or after prostatectomy, and is caused by the damage to the peripheral nerves.
- Endocrine – occurs even in good health, since the levels of male hormones inevitably decrease with age.
- Penile – caused by direct damage of the male reproductive organs.
The risk of worsening sexual health increases with age. In 80% of cases, the men suffering from erectile dysfunction are also diagnosed with other organic pathologies. Most patients suffer from atherosclerosis, obesity, diabetes mellitus, and have high blood pressure. A temporary deterioration in erection can be caused by poisons, drugs, alcohol.
Diagnostics
With erectile dysfunction, patients complain about the inability to achieve an erection sufficient for satisfactory sexual intercourse. The doctor's task is to find out the causes of this condition and eliminate them, if possible. Important information is obtained already at the stage of interviewing men with erectile dysfunction.
Healthcare professionals abroad use various questionnaires that help determine the cause and degree of deterioration in sexual health:
- International Index of Erectile Function (IIEF-5).
- Aging Male's Symptoms (AMS) Scale.
- Male Copulative Function (ICF) Scale.
- Hospital Anxiety and Depression Scale.
Laboratory tests are required to determine male sex hormones, glucose and glycated hemoglobin, and indicators of lipid metabolism. General clinical tests are performed to assess the patient's health.
Special tests:
- Pharmaco‐penile Doppler ultrasound.
- Nocturnal penile tumescence and rigidity monitoring.
- Endothelial function assessment.
- Cavernosography – contrast-enhanced CT or MRI scanning.
A new direction in the diagnostics of erectile dysfunction is the assessment of the status of endothelial dysfunction. The endothelium is the inner layer of the blood vessels. It determines the healthy condition of the entire arterial bed. Impairment of chemical processes in the endothelium leads to vasoconstriction and impaired blood flow to the penis.
To assess the health of the penis, doctors abroad also use neurophysiological tests, cavernosography, arteriography and sonography with 3D reconstruction. Cutting-edge technologies ensure accurate diagnostics of erectile dysfunction, which is important for planning treatment for the disease.
Treatment
Treatment of erectile dysfunction can be invasive and non-invasive. Either option can be used as first-line therapy. Non-invasive treatment is more sparing and has greater adherence among patients. On the other side, invasive interventions are often able to provide more lasting results, and also ensure a spontaneity of sexual activity (no need to take a pill before sexual intercourse).
The main treatments for patients with sexual dysfunction are:
- Medicines for erection improvement.
- Hormones.
- Local negative pressure.
- Lifestyle modification.
- Shockwave therapy.
- Injection of vasoactive drugs (vasodilators) into the penis.
- Stem cells and platelet-rich plasma.
- Phalloprosthetics.
- Implantation of external penile implants.
- Surgical revascularization (restoration of blood supply to the penis).
- X-ray-guided vascular surgery.
Non-drug therapy
Whenever possible, it is worth starting with a lifestyle modification. It does not provide immediate results, but improves the course of the disease, slows down its progression, and increases the effectiveness of the treatment of erectile dysfunction. Patients are advised to eat healthy foods, give up alcohol, drugs, quit smoking, normalize weight, and exercise regularly. A healthy lifestyle affects all the mechanisms of the development of erectile dysfunction at once:
- Improvement of vascular health.
- Improvement of mental health.
- Prevention or help in diabetes management.
- Elimination of the effect of toxins on sexual health.
- Increase of the production of male sex hormones.
In recent years, a comprehensive approach has been increasingly used in the conservative treatment of erectile dysfunction, acting on several of its causes at once. This is due to the fact that in many patients the deterioration of health is due to the simultaneous influence of vascular, endocrine and psychological causes.
The treatment for these patients often includes not only pharmacotherapy, but also psychotherapy. It is provided by sexologists and psychotherapists. This treatment option may be the primary one in young men with good physical health but symptoms of anxiety and depression. In such cases, it achieves better results than medicines. In elderly patients, it is used as an adjunct to the main treatment for erectile dysfunction in order to improve therapeutic results.
Vacuum erectile device (VED) is used for situational treatment. The penis is placed in it. A pump creates negative pressure. It causes vasodilation and blood flow. A ring is then placed on the penis to prevent blood outflow after the disconnection of the device. The technology is used for both vascular and neurogenic dysfunction. It has proven itself well for the treatment of impotence after prostatectomy.
Drug therapy
Phosphodiesterase type5 (PDE5) inhibitors with Viagra are the main treatment for vascular erectile dysfunction. There are several drugs of this pharmacological group, which differ in the speed of onset and duration of the effect. They are taken on demand, namely, when intercourse is planned. They do not have a long-term positive effect on the course of the disease, and the progression of the pathology does not slow down. Long-acting PDE5 inhibitors are prescribed for those patients who have a regular sexual life. The effect after taking them lasts for several days.
Other means are less commonly used. These include:
- Hormone replacement therapy with testosterone that is prescribed to young men with hypogonadism, as well as to older men, whose hormone levels have decreased due to physiological involution of the testes.
- Drug therapy of diabetes mellitus, which is a common cause of damage to the penile nerves and blood vessels.
- Intracavernous injections that imply the administration of vasodilators into the penis (second-line therapy for vascular erectile dysfunction, if PDE5 inhibitors do not give the desired result).
- Intraurethral suppositories with prostaglandins are a non-invasive alternative to penile injections (suppositories are inserted into the urethra).
Penile revascularization surgery
If the penile vessels are damaged, they can be expanded or, on the contrary, blocked to prevent the blood outflow from the corpus cavernosum. Surgical procedures for vascular erectile dysfunction can be performed using both open and minimally invasive techniques.
Over the past few years, the preference has been given to endovascular techniques abroad. Interventions are performed through the blood vessels. The doctor makes a small incision in the groin, inserts a catheter through it, reaches the target vessels and performs the necessary manipulations. The intervention is performed under X-ray guidance.
The following types of endovascular procedures can be used for erectile dysfunction:
- Vascular stenting involves the placement of a metal frame that keeps the lumen of the artery open.
- Balloon angioplasty is the dilation of the vessel using a balloon that is inflated with saline.
- Coil vein embolization blocks the blood outflow from the penis. The procedure is often complemented by X-ray-guided vascular elimination of arteriovenous conflicts.
Stem cells
On the one hand, the treatment of erectile dysfunction with stem cells is an innovative and promising method, on the other hand, it has not yet been sufficiently researched. The first experiments on mice were carried out only in 2004, and the first application in humans took place in 2010. Therefore, the therapy is not yet considered a standard therapy.
But so far, many clinical studies have already been carried out, which have shown good results. Bone marrow, blood, adipose tissue, and umbilical cord blood are used as sources of stem cells. They are usually autologous (patient's own), much less often – allogeneic (donor).
In the United States, the procedures using the stromal vascular fraction have become most popular for the cell therapy of erectile dysfunction. It is obtained from the patient's adipose tissue. After receiving the adipose tissue, it is placed in a special apparatus, which produces a stromal vascular fraction rich in stem cells. There are so many cells here that cultivation is not required. However, there is also a minus: the procedure is invasive, because it requires obtaining several tens of milliliters of adipose tissue.
In Europe, peripheral blood is used more often. The procedure for collecting cells is fast and minimally invasive (intravenous injection). There are few stem cells, but they are cultured to increase their number. Several million cells are then injected into the corpora cavernosa. Under their influence, damaged tissues are restored, the state of blood vessels improves and erectile function normalizes.
Treatment in Europe with Booking Health at an affordable price
To undergo erectile dysfunction treatment in one of the European hospitals, you can use the services of the Booking Health company. On our website, you can see the cost of treatment and compare prices in different hospitals in order to book a medical care program at a favorable price. Treatment in European hospitals will be easier and faster for you, and the cost of treatment will be lower.
You are welcome to leave your request on the Booking Health website. Our specialist will contact you and provide a consultation on treatment in Europe. Booking Health will fully organize your trip abroad. We provide the following benefits for you:
- We will choose the best European hospital, whose doctors specialize in the treatment of erectile dysfunction.
- We will help you overcome the language barrier and establish communication with the doctor of the European hospital.
- We will reduce the waiting time for the medical care program. You will undergo treatment on the most suitable dates for you.
- We will reduce the price. The cost of treatment in Europe will be lower due to the lack of overpricing and additional coefficients for foreign patients.
- We will take care of all organizational issues: we will draw up documents, meet you abroad and take you to the hospital, book a hotel, and provide interpreting services.
- We will prepare the program and translate medical records. You do not have to repeat the previously performed diagnostic procedures.
- We will help you keep in touch with doctors after the completion of treatment in Europe.
- We will organize additional diagnostic examinations and treatment in European hospitals.
- We will buy medicines abroad and forward them to your native country.
Your health will be in the safe hands of the world's leading doctors. The Booking Health specialists will help you reduce the cost of treatment, organize your trip to a European hospital, and you will only have to focus on restoring your health.
Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed
