Erectile Dysfunction. Treatment in Germany

Erectile dysfunction is a persistent inability to achieve or maintain an erection for sexual intercourse. It reduces the quality of life for men and is usually a harbinger of cardiovascular disease. Symptomatic treatment of pathology is carried out mainly with the help of medications. If medicines do not work, then doctors resort to surgical and endovascular interventions. Germany offers the very latest methods for erectile dysfunction treatment, including revascularization, penile reinnervation, stem cell therapy and modern options for phalloprosthetics.

Content

1. Diagnostics
2. Treatment principles
3. Elimination of the causes of erectile dysfunction
4. Specific therapy for erectile dysfunction
5. Surgery for erectile dysfunction
6. Innovative treatment
7. Treatment in Germany with Booking Health at an affordable price

Diagnostics

All patients undergo a thorough diagnostic examination to assess their health status, primarily to find out the causes and leading mechanisms of the development of erectile dysfunction. This pathology is not a separate disease, but a symptom of a wide variety of diseases: vascular, nervous, endocrine, reproductive.

Here are some specific diagnostic tests for erectile function assessment: 

• Nocturnal penile tumescence and evaluation of penile erection rigidity check if the erectile mechanism is preserved.
• Intracavernous injection test assesses the state of the blood vessels, but does not have an independent diagnostic value, and therefore it is used in combination with ultrasound.
• Duplex ultrasound scanning of the penile blood vessels is the main method for assessing blood flow in the penis.
• Arteriography and dynamic infusion cavernosometry or cavernosography is a more accurate contrast-enhanced diagnostic test of the blood vessels, which is required only when planning surgical or endovascular treatment.

If erectile dysfunction occurs before the age of 40 without obvious organic causes, a consultation with a psychotherapist or a psychiatrist is required.

Treatment principles

For patients with erectile dysfunction, treatment is carried out in stages. Doctors start with the first-line therapy, and if it does not work, they switch to the second one. Preference is given to less invasive techniques, simpler and cheaper ones. But if they do not work, endovascular procedures or surgical interventions may be required. They usually provide a more consistent clinical outcome.

The initial directions of treatment for erectile dysfunction are as follows: 

• Identification and elimination of the causes of the disease.
• Lifestyle modification and elimination of risk factors.
• Patient training and counseling of his partners.

The next stage is the combination treatment of erectile dysfunction itself. This is pharmacotherapy combined with psychological therapy, which is practiced by psychotherapists and sexologists.

If conservative treatment does not work, they switch to invasive procedures, as well as non-standard methods of treatment, including innovative ones. The main options for surgical interventions are open surgery and endovascular procedures to restore blood supply to the penis. In extreme cases, when the restoration of a natural erection is impossible, doctors resort to phalloprosthetics.

Elimination of the causes of erectile dysfunction

Erectile dysfunction always has specific causes. Some diseases that interfere with erection can be eliminated or controlled.

Depending on the cause of erectile dysfunction, there are 6 types of this disorder: 

• Vascular – the most common type of erectile dysfunction that occurs in older men due to the damage to the arteries and veins. 
• Psychogenic – occurs against the background of emotional experiences or mental disorders, and it is more typical for young men.
• Neurogenic – associated with diseases of the nervous system, both central and peripheral ones. 
• Penile – occurs due to congenital structural features, damage or disease of the genital organs.
• Endocrine – most often develops due to testosterone deficiency.
• Medication-induced – potentially reversible, arising as a side effect of medications. 

Most patients are diagnosed with vascular erectile dysfunction, which develops due to atherosclerosis. As a rule, it affects elderly men, and is often combined with cardiovascular pathologies. The treatment requires improved vascular health: statins are used to lower cholesterol levels, correct blood pressure, normalize weight. Patients are advised to quit smoking and exercise regularly. All these measures not only improve erectile function, but also have a beneficial effect on health in general.

Neurogenic erectile dysfunction can have central and peripheral causes.

Central ones include Parkinson's disease, stroke, multiple sclerosis, trauma and spinal cord diseases. Such patients require elimination or compensation of the underlying pathology, including the use of neurosurgical interventions.

The most common peripheral cause is diabetes mellitus. Patients need adequate hypoglycemic therapy, insulin, and diet to control this disorder. Less commonly, damage to the peripheral nerves is associated with prostatectomy, pelvic irradiation, pelvic surgery, and retroperitoneal surgery.

Penile (anatomical) erectile dysfunction occurs due to congenital and acquired diseases: micropenis, hypospadias and epispadias, Peyronie's disease. The treatment involves surgical interventions.

The main hormonal causes of erectile dysfunction are hypogonadism or age-related androgen deficiency. Hypogonadism is a testosterone deficiency in young men due to testicular or pituitary failure. It can be primary or secondary. Both types of the pathology are treated with hormones, but different ones: patients are given testosterone replacement therapy or gonadotropins, which stimulate testosterone production in the testicles. Less commonly, hormonal erectile dysfunction is associated with increased prolactin levels, increased or decreased  thyroid and adrenal hormone levels. All of these causes must be corrected, but some patients will require surgery to remove hormone-producing masses.

As for medication-induced erectile dysfunction, it is most often caused by antidepressants, diuretics, antiandrogens, and drugs. To improve erection, it is enough to stop taking them. Some medicines can be replaced with drugs with similar pharmacological effects. If replacement is not possible, symptomatic pharmacotherapy for erectile dysfunction becomes an option of choice. 

Specific therapy for erectile dysfunction

Dysfunction treatment aimed directly at improving erection includes the following: 

• PDE5 (phosphodiesterase) inhibitors for penile vasodilation.
• Antispasmodics and prostaglandins (as second-line medications).
• Local negative pressure therapy.
• Psychotherapy. 

The main drugs are PDE5 inhibitors. They dilate blood vessels for several hours, while the effect of some medicines can last for several days. These medications are not usually used all the time. They are taken on demand, shortly before sexual intercourse. They only solve the problem of vascular erectile dysfunction.

Doctors in Germany often combine pharmacotherapy with psychotherapy. The best results are obtained in young men with good vascular health. However, older men can also benefit from such dysfunction treatment. Psychotherapy can increase the effectiveness of pharmacotherapy and reduce the need to use medications.

In some patients, PDE5 inhibitors do not work or provide insufficient effect. In such a case, doctors switch to the second-line therapy for dysfunction treatment:  

• Intracavernous administration of vasodilators (injections into the penis).
• Urethral micro-suppositories (suppositories that are inserted into the urethra).
• Vacuum devices. 

All these methods for erectile dysfunction are used immediately before sexual intercourse. They allow achieving an erection for a while, but these treatment options for dysfunction do not give a long-term effect. While taking any medications, including PDE5 inhibitors, the disease may continue to progress. Thus, specific conservative treatment of erectile dysfunction is mainly symptomatic.

Surgery for erectile dysfunction

The standard surgery for erectile dysfunction is phalloprosthetics. Other surgical procedures are less common.

Surgeons in Germany implant new types of phalloprostheses, consisting of several inflatable cylinders and a pump placed in the scrotum. With its help, fluid is injected into the cylinders, and thus an erection close to natural is achieved. The best are three-piece systems with a reservoir behind the pubis.

For the treatment of erectile dysfunction of vascular origin, penile revascularization surgery is used. It can be not only open, but also endovascular, which means that the surgical procedure is performed from the inside of the vessels. Such interventions are minimally traumatic and safe for health. This innovative treatment option is not available everywhere, but patients with erectile dysfunction can use the services of German doctors to undergo such a surgical intervention.

Prior to endovascular dysfunction  treatment, patients are carefully examined to establish the mechanism of erectile dysfunction. It is then eliminated in various ways. Doctors usually perform the following procedures:

• Stenting involves dilating a narrowed artery from the inside with the help of a frame placed in its lumen. 
• Angioplasty involves dilating an artery from the inside with an inflating balloon. 
• Embolization involves closing the lumen of a vein with coils or chemicals to prevent blood from flowing out of the penis. 

Innovative treatment

As an experimental treatment of erectile dysfunction of neurogenic origin, penile reinnervation surgery is performed abroad. Doctors take the sural nerve, suture its one end to the trunk of the femoral nerve and the other to the tunica albuginea of the corpora cavernosa. As a result, the innervation of the organ is restored. Erection returns in 70% of patients.

Some hospitals use low-energy shockwave therapy. It improves erectile function by stimulating the growth of blood vessels. The technology was first used for erectile dysfunction treatment in 2010. It is well tolerated and safe for health. The technology is considered experimental, although more and more studies are accumulating on it, and they are usually successful. Nonetheless, the effect of the procedure is gradually weakening: a month after the end of therapy, it decreases by a third, after 2 years – by two thirds.

For erectile dysfunction in Germany, doctors are increasingly using stem cells. They are used for a large number of pathologies to restore organs and tissues. The patient's own stem cells are safe for health, but they are recently used, insufficiently researched, and therefore are not included in the standard of dysfunction treatment. When conducting stem cell therapy, these cells are injected into the corpora cavernosa of the penis. An improvement in erection can be expected after a few weeks, and the effect lasts for several months.

Treatment in Germany with Booking Health at an affordable price

To undergo erectile dysfunction (impotence) treatment in one of the German hospitals, you can use the services of the Booking Health company. On our website, you can find out the cost of treatment and compare prices in different hospitals in order to book a medical program at a favorable price. Treatment in German 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 Germany. Booking Health will fully organize your trip to Berlin. We will provide the following benefits for you:

• We will select the best German hospital, whose doctors specialize in erectile dysfunction treatment. 
• We will solve the problem of the language barrier, and take care of your communication with the doctor of the German hospital.
• We will reduce the waiting time for the medical care program. You will undergo treatment in Berlin on the most suitable dates for you.
• We will reduce the price. The cost of treatment in Germany will be lower due to the lack of overpricing and additional coefficients for foreign patients.
• We will solve any organizational issues: we will draw up documents, meet you in Germany and take you to the hospital, book a hotel in Berlin, and provide interpreting services.
• We will prepare a program and translate medical documents. 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 Germany.
• We will organize additional diagnostic examinations and treatment in German hospitals.
• We will buy medicines in Germany 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 reduce the cost of treatment, organize your trip to a German hospital, and you can fully focus on restoring your health.

Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed