Erectile Dysfunction
Erectile Dysfunction (ED) is a condition whereby a man has difficulties getting or maintaining an erection in order to engage in sexual intercourse. According to the National Institute of Diabetes and Digestive and Kidney Diseases, around 12 percent of men under the age of 50 have ED.
Causes:
There are 2 types of erectile dysfunction (ED):
- Primary ED, the man has never been able to attain or sustain an erection.
- Secondary ED, acquired later in life by a man who previously was able to attain erections.
Primary ED is rare and is almost always due to psychologic factors or clinically obvious anatomic abnormalities. Secondary ED is more common, and > 90% of cases have an organic causes. Many men with secondary ED also develop reactive/add-on psychologic difficulties that compound the problem.
Psychologic factors, whether primary or reactive, may be contributary in most if not all cases of ED. Psychologic causes of primary ED include guilt, fear of intimacy, depression, or anxiety. In secondary ED, causes may relate to performance anxiety, stress, or depression. Psychogenic ED may be situational, involving a particular place, time, or partner.
The major organic causes of ED are:
- Physiologic (organic)
- Vascular disorders( related to blood flow)
- Neurologic disorders( related to nerves)
The most common vascular cause is atherosclerosis (thickening of the walls of the small arteries)of cavernous arteries of the penis, often caused by smoking, endothelial dysfunction, and diabetes. Atherosclerosis and aging decrease the capacity for dilation of arterial blood vessels and smooth muscle relaxation, limiting the amount of blood that can enter the penis. Endothelial dysfunction is a disease of the endothelial lining of the small arterioles that reduces the ability to vasodilate when needed to increase blood flow. Endothelial dysfunction appears to be mediated by reduced levels of nitric oxide and can result from smoking, diabetes, and/or low testosterone levels. Veno-occlusive dysfunction permits venous leakage, which results in inability to maintain erection.( all of these factors have been used to target ED in terms of use of specific drugs and also in regenerative therapy via stem Cells).
Priapism may lead to ED by causing fibrosis of the corpora cavernosa and thus impairment of the penile blood flow necessary for erection.
Neurologic causes include stroke, partial complex seizures, multiple sclerosis, peripheral and autonomic neuropathies, and spinal cord injuries. Diabetic neuropathy and surgical injury are particularly common causes.
Complications of pelvic surgery (eg, radical prostatectomy [even with nerve-sparing techniques], radical cystectomy, rectal cancer surgery) are other common causes. Occasionally, transurethral resection of the prostate is a cause. Other causes include hormonal disorders, drugs, pelvic radiation, and structural disorders of the penis. Prolonged perineal pressure (as occurs during bicycle riding) or pelvic or perineal trauma can cause ED.
Any endocrinopathy or aging associated with testosterone deficiency may decrease libido and cause ED. However, erectile function only rarely improves with normalization of serum testosterone levels because most affected men also have neurovascular causes of ED.
Numerous drugs and substance /Alcohol abuse may also Cause temporary ED
Diagnosis
- Clinical evaluation: done by the specialist
- Screening for depression
- Testosterone level along with other tests like duplex scans are done to find out the status of the penile architecture and blood flow.
Treatment
- Treatment of underlying causes
- Drugs, usually oral phosphodiesterase inhibitors( sidenafil)
- Vacuum erection device or intra-cavernosal or intraurethral prostaglandin E1 (2nd-line treatment)
- If other treatments fail, surgical implantation of penile prosthesis
Stem cell therapy
Most of the times the drug therapy is not long lasting and complication of the surgical implants my not be acceptable to the patient. Thus, stem cell therapy may benefit a select few to give them long term results.
There are many different types of stem cells. For the treatment of erectile dysfunction, two types of adult stem cells are commonly used:
- Adipose tissue-derived stem cells (ADSCs), harvested from the body’s own fat
- Bone marrow-derived stem cells (BMSCs)
Why Fat Stem Cells?
Harvesting adipose-derived stem cells (ADSCs) is much easier and less invasive than harvesting either bone marrow or muscle-derived stem cells. Fat is abundant in the body and is obtained using minimally invasive liposuction. ADSCs have a significantly higher concentration of mesenchymal stem cells, which have the ability to self-renew, clone, and differentiate into multiple tissues.
This procedure is also referred to as autologous stem cell therapy, which means the donor and the recipient are the same people. Because of the high volume of stem cells found in fat tissue, there is no need to culture the cells or wait for them to grow. (However , in select few allogenic stem cells may also be used with almost similar results.) They can be harvested, concentrated into a stem cell-rich mixture and re-injected into the treatment area on the same day of the procedure.
At The Living Cells, we use Stem cells isolated from the patient’s own Bone Marrow and Adipose Tissue which may differ from case to case. These isolated sources are processed to separate Stem Cells. These harvested stem cells are enriched with growth, cytokines and other cells active factors which are responsible for repair and regeneration action. These isolated Stem Cells are injected into the Penile artery via catheter / into the erectile tissue of the penis. The therapy results in improving muscle strength, endothelium and/or nerve in erectile tissue , all leading to a significant and sustained improvement in ED.