Low energy lithotripsy and stem cells for ED.

Penile extracorporeal low-intensity shock wave therapy (LIST) to the penis has recently emerged as a novel and promising modality in the treatment of erectile dysfunction (ED). LIST has angiogenic properties and stimulates neovascularization. If applied to the corpora cavernosa, LIST can improve penile blood flow and endothelial function. In a series of clinical trials, including randomized double-blind sham-controlled studies, LIST has been shown to have a substantial effect on penile hemodynamics and erectile function in patients with vasculogenic ED. The response to LIST wanes gradually over time, and after 2 years, about half of the patients maintain their function. In other words the results of LIST on ED thus far are variable. The age of the patient and the severity of the ED makes a significant difference on the magnitude and longevity of the outcome. If one looks across the data available using LIST and look at the age related response, it becomes obvious that if the patient is over 60 y/o and or chronically suffers from diabetes, or vascular disease, the response is sub-optimal as evidenced by the pre/post-treatment ED IIEF-5 questionare at 24months.

LIST has also been studied in regard to its effect on stem cell recruitment in tissue repair. Stem cells and progenitor cells have the ability to divide and differentiate into specialized cell types. Their key role in the neovascularization of ischemic tissues was widely studied in recent years [13]. One example is the circulating progenitor cells (CPCs) or adult stem cells. During acute ischemia, the release of chemoattractant factors (i.e., VEGF) acts as a homing factor for CPCs (adult stem cells) that may contribute to the ongoing endothelial repair [14]. Aicher et al. [5] investigated the effect of LIST on the homing of infused human CPCs (adult stem cells) in rats with chronic hind limb ischemia.LIST-treated ischemic muscles attracted significantly more labeled CPCs (adult stem cells)than did the untreated muscles. The treatment significantly increased the blood flow in the ischemic muscles. Nishida et al.

In conclussion, it seems that the magnitude and longevity of the LIST treated ED seems to be readily explained by recruiting, activating and proliferation of stem cells into endothelial cells via VEGF facilitated new blood vessel formation. This is in big part the reason and rationale of combining LIST and stem cell therapy in order to exponentially augment the magnitude and longevity of results on ED. This, in our experience, explains the dramatic and sustained response we have observed in our stem cell program patients of all ages. To just do LIST for ED, in our opinion continues to be a temporary solution requiring to repeat the treatment indefinitely, particularly again for those who might be older and/or have more medical conditions that affect their vascular health (diabetes,HTN,cholesteronemia, heart disease,smokers, etc.), or following prostate surgery/biopsy. Augmenting stem cell therapy with LIST simply makes sense given the data about how these procedures work and we have proven their superb efficacy and longevity when used together.

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Melvin A. Martinez-Castrillon, MD