Melvin A. Martinez-Castrillon, MD

ERECTILE DYSFUNCTION

TREATMENT WITH STEM CELLS

Why Stem Cells for ED?

ED is mostly (83%) due to vascular flow problems, this is why Autologous Stem Cell transplantation via injections have resulted in such dramatic improvements in this field.  Over 84% of those treated with Stem Cell injections for ED report improvement of the magnitude of having erections comparable to pre-ED times!!  This has been observed not only here in the US but in Europe, Asia and even the middle east.   Once stem cells are deployed to the corpous cavernosa of your penis they begin to create new blood vessels (angiogenesis or neovascularization we call that) re-establishing/improving significantly blood flow to the penis and in turn improve both your erection, and the sustainment of the erection. Stem cells are also unique in that they also improve neurological function, as in following a prostate procedure (removal or biopsy) where CNI (Cavernous nerve injury) or neuropraxia is a common cause of ED. To dramatically enhance the response of the stem cells we pre-treat our patient with localized, low intensity ultrasound shock wave therapy in order to significantly increase the amount of angiogenesis stimulating markers, vascular endothelial growth factor 1&2  (VEGF 1&2) just before we perform our stem cell therapy. We also pair this with tailored bio identical testosterone replacement therapy when appropriate.  We have developed the Revitasem protocol, incorporating stem celll, individualized low intensity shock wave therapy and tailored bio identical  testosterone management. This combination produces unprecedented results that are long lasting, we call it the Revitastem  protocol. Revitastem set us apart from any other single modalities of treating ED. No more pills or cumbersome suction devices.  This is a new era in treating ED,  this is why treating the underlying vascular/neurological patophysiology improves ED. It is nothing short of fascinating to know that stem cells not only can generate new blood vessels but also can improve nerve function as well! Stem cells have been proven to re-generate axonal growth and function. This is particularly great news for patients struggling with ED post prostate surgery/biopsy/radiation, see below. 

 

     If you are taking Viagra, Cialis and/or similar phosphodiesterase inhibitor drugs or injecting similar drugs into your penis with good/fair  results, then that in fact proves that you would respond favorably to Revitastem/Stem cell therapy, since that is what these drugs do temporarily, (increase blood flow into your penis), but Revitastem/Stem cell therapy would improve this underlying problem in a more permanent way. Pills or injections for ED do nothing to attempt treat the underlying problem, their effect is strictly temporary. If you or your loved one is struggling with ED  I strongly recommend you consider making an appointment to asses if this new therapy can be of help. 

Prostate surgery/biopsy related ED

In treating prostate cancer one of the many modalities available, surgery is sometimes appropriate. Unfortunately by performing surgery and removing the prostate along with the cancer and or using radiation/cryotherapy to treat the cancer invariably ED occurs as a byproduct. The fact remains that after prostatectomy ALL men will have ED at least for several weeks to months. About half will also develop urinary incontinence. The numbers are not encouraging since even after 24months following prostate surgery on average 55-60% will still have ED. The mechanisms for this are several and depend on how long ago the procedure was done and weather you had ED before the procedure and the particular anatomic extent of the cancer. Initially inflammation and/or CNI (cavernous nerve injury) in the area means that 100% will have ED and at least 50% will have urinary incontinence. Later when inflammation subsides by about 8 weeks, then the ED is caused by the fact that neurapraxia or nerve injury/dysfunction to the cavernous nerves (CNI) has occurred. Without proper nerve function there is no proper release of a compound called nitrous oxide (NO) during the arousal phase of your sexual act, which is supposed to tell your main blood chamber in your penis to fill up with blood in order to have an erection. This is known to happen after some prostate biopsies as well.  This ED secondary to cavernous nerve injury (CNI) of course is devastating for these men and their sexual partners. Not unusually many despite best conventional med tx simply give up altogether on their sex life with its emotional effects on their relationships.

 

Stem cells are particularly positioned to quickly become a superb addition to treating ED post prostatectomy/biopsy  because of its effects not only on the vascular but also on the neurological problems associated to prostate surgery/biopsy  i.e. physical injury to the cavernous nerves (CNI) and or neurapraxia that on most can last out to 24months. Stem cell autotransplantation have been shown to both be safe and  improve both CNI and blood flow following prostate surgery and allowing patients to have erections capable of sustaining sex again (Dr. Haar et. al. Denmark, March 2017).

 

What is erectile dysfunction (ED)?

Having ED means that you cannot get and/or maintain an erection. In some cases the penis becomes partly erect but not hard enough to have sex properly. In some cases, there is no swelling or fullness of the penis at all. ED is sometimes called impotence as well, although this term mostly is applied when there is a non-physical cause for your ED.

How common is erectile dysfunction (ED)?

Most men have occasional times when they cannot get an erection. For example, you may not get an erection so easily if you are tired, stressed, distracted, or have sonsumed too much alcohol. For most men it is only temporary and an erection occurs most times when you are sexually aroused. However, some men have persistent, or recurring, ED. It can occur at any age but becomes more common with increasing age. About half of men between the ages of 40 and 70 have ED. About 7 in 10 men aged 70 and above have ED, but is never normal at any age according to experts.

How does an erection normally occur?

When you are sexually aroused, messages from your brain travel down nerves to your penis. Chemicals signals called neurotransmitters are then released from the ends of the nerves in the penis. These signals in turn increase blood flow in to the main blood chamber (corpora cavernosa) that in turn produces your penis to become erect. The speed at which this blood flow occurs seems to be important in avoiding the penis to become flaccid before it is supposed to. 

What causes erectile dysfunction (ED)?

There are several causes which tend to be grouped into those that are mainly physical and those that are mainly due to mental health (psychological).

Physical causes

About 8 in 10 cases of ED are due to a physical cause. Causes include:

  • Reduced blood flow to the penis. This is, by far, the most common cause of ED in men over the age of 40. Like in other parts of the body, the arteries which take blood to the penis can become narrowed. The blood flow may then not be enough to cause an erection. Risk factors can increase your chance of narrowing of the arteries. These include getting older, high blood pressurehigh cholesterol and  smoking.
     

  • Diseases which affect the nerves going to the penis. For example, multiple sclerosis, a stroke, Parkinson's disease, etc.
     

  • Diabetes. This is one of the most common causes of ED. Diabetes can affect blood vessels as well as the nerves in your penis.
     

  • Hormonal causes. For example, a lack of a hormone called testosterone which is made in the testicles (testes). Low testosterone is a fairly common occurrence as we age.  Other symptoms of a low testosterone level include a reduced sex drive (libido) and changes in mood.
     

  • Injury to the nerves going to the penis. For example, spinal injury, following surgery to nearby structures, like radical prostactectomy,  fractured pelvis, radiotherapy to the genital area, etc. A common one is cycling frequently without proper setting the saddle height for you, fortunately if the saddle position is corrected, no significant ED is reported.
     

  • Side-effect of certain medicines. The most common are some antidepressants; beta-blockers such as propranolol, atenolol, etc; some 'water tablets' (diuretics); cimetidine. Many other less commonly used tablets sometimes cause ED.
     

  • Alcohol in excess and drug abuse.
     

  • Sickle cell disease. This is more common in African americans, this blood disorder causes flow "crises" that in turn scar your penis blood chamber rendering it unable to produce a satisfactory erection. 

  • Peyronie's disease is caused by repeated penile injury, typically during sex or physical activity. Penises vary in shape and size, and having a curved erection isn't necessarily a cause for concern. In Peyronie's disease, the bend is significant, and may occur along with pain or interfere with sexual function as ED.

In most cases due to physical causes (apart from injury or after surgery), the ED tends to develop slowly. So, you may have intermittent or partial ED for a while, which may gradually become worse. If the ED is due to a physical cause, you are likely still to have a normal sex drive, apart from it the cause could also be due to a hormonal problem. In some cases, ED causes poor self-esteem, anxiety and even depression. These reactions to ED can make the problem worse.

Erectile dysfunction (ED), heart disease and other vascular diseases

Although ED can be caused by various conditions, about 7 in 10 cases are due to narrowing of the small arteries in the penis. This causes reduced blood flow to the penis particularly on the initial filling up phase while initiating an erection. This is the same problem that can occur in other blood vessels beds or regions. For example, narrowing of the blood vessels in the heart (the coronary arteries) is a cause of angina and other heart problems. Narrowing of blood vessels to the brain is a risk factor for having a stroke. Narrowing of blood vessels in the legs can cause peripheral arterial disease. This is why treating ED with stem cell therapy has demonstrated such significant improvements.