ED is defined as inability to attain or sustain an erection satisfactory for sexual intercourse. Its etiology includes a myriad of possible causes. However, the commonest categories responsible are: vascular, neurogenic, and hormonal disorders; and drug use/abuse and psychological issues. There are four basic requirements for a satisfactory erection: psychological drive, neurological signals via the spinal cord to the penis, an uninterrupted blood supply to the penis and a functional target tissue in the penis. Any significant pathophysiology of any of these 4 systems may result in ED.
Primary ED where the man has never had an erection is very rare. It may have an anatomical (congenital or traumatic) cause; or the etiology may be psychological, due to a sense of guilt, fear, depression etc. Secondary ED is much more common and % the cause is organic. The majority of these are either vascular or neurological. However, although atherosclerosis, often with diabetes, heads the list, psychology negativity creeps in with time to complicate matters. Arterial diseases can affect various sites along the supply-route of blood from the heart to the penis, causing blockages and ischemia. These can range from partial to total occlusions of the aorta and major branches by atheroma, dysphasia or dissection; to small vessel disease, pathognomonic of diabetes. Diabetes Mellitus (sugar diabetes) may also contribute to ED by effecting a “neuropathy” of the autonomic nervous system supplying the genitalia. Most men with spinal cord damage by disease or trauma suffer from ED. ED can also arise as a complication of prostate surgery and structural penile disease (like Peyronie’s).
ED can be caused by endocrine and hormonal changes, and intake of various drugs. Yes, drugs! Prescription and non-prescription drugs alike! The two commonest and largest groups of drugs that may cause ED are those for the central nervous system (especially amphetamines) and anti-hypertensives, including Alpha and beta-blockers.
Diagnosis and Treatment of ED
Phosphodiesterase inhibitors (Viagra and others) are very popular and work, so long as there is no serious blockages or nerve damage. They work through the mediation of nitric oxide’s action on the blood supply to the penis increasing it, causing tumescence. They can cause a significant hypotension, and are not recommended for those with severe ischemic heart disease. Afflictions of the larger vessels carrying blood from the heart to the penis and testicles are often amenable to treatment by balloon angioplasty (with or without stenting) or by surgical bypass or replacement of the culprit vessel. Mechanical pump devices and surgical implants are used as a last resort, and carry the common risks of all foreign bodies- primarily infection.
More recently, two new modalities have appeared on the ED scene. These are acoustic shock wave therapy (ASWT), using the D-Actor 200 machine, from Storz of Switzerland and stem cell therapy.
STEM CELL TREATMENT
Stem cells are found in every tissue of our bodies. They help to repair and generate new cells to replace damaged or effete cells. The two most accessible stem cell sources in the adult body are the adipose (fat) tissue and bone marrow stem cells. Stem cells from fat tissue are more plentiful and are readily available in huge numbers, while those from bone marrow are fewer in number and are not readily available since they have to undergo growth in culture to increase their numbers.
For treatment with stem cells with only need to harvest 2-3 ounces of fat under strictly sterile conditions by mini-liposuction. We use a totally closed system in a sterile field, under local anesthesia. We use mild oral sedatives that patients find convenient. The process of harvest takes about 20 minutes. Separating the stem cells from the fat takes about 90 minutes in our closed system. We end up with about half an ounce of sterile liquid, containing millions of stem cells along with scores of growth factors and cytokines, ready to go to work.
ACOUSTIC SHOCK WAVE and COMBINATION THERAPY
The D-Actor works by causing micro-stress of the genital tissues, at the cellular level, that leads to improved metabolism, repair and rejuvenation, partly by activation of dormant stem cells and new vessel formation. The painless ASWT is delivered to the phallus over the skin, once or twice a week for a total of 6 sessions. However, if ASWT were combined with stem cell therapy, then only 3 sessions of the D-Actor would suffice. The combination of ASWT and stem cell therapy appears to be far more effective than either of these modalities used alone. The stem cells and growth factors, obtained from a mere 2 ounces of the patient’s own fat under local anesthesia, provide the fuel to repair the degenerative changes, not only in the genitalia but possibly in other places in the body as well.
We have reports of improvement of ED within days. However, firm results may take longer. The procedure is safe, with minimal theoretical complications.
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