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Erectile Dysfunction (ED)

Erectile Dysfunction (ED) is defined as the inability to achieve or sustain an erection suitable for sexual intercourse. ED affects up to one third of men of men throughout their lives and has a substantial negative impact on intimate relationships, quality of life and self-esteem. Causes are multifactorial but can be related to loss of testosterone, surgical damage to the penile nerves, medications, or other medical illnesses. The most common cause of ED is “vasculopathy”, which is damage to the delicate blood vessels in the penis. This vasculopathy is often associated with age but strongly related to atherosclerosis, diabetes, hypertension, high cholesterol and cerebrovascular and peripheral vascular disease.  Vasculopathy is also very prominent in patients with Peyronies disease and penile scarring. Men with ED are also at significantly increased risk of coronary artery disease. Therefore, when men have ED, screening for cardiovascular risk factors should be considered because symptoms of ED present as much as three years earlier than other symptoms of coronary artery disease such as chest pain. The current treatment of ED centers around the use of Phosphodiesterase type 5 inhibitors such as Viagra, Cialis, or Levitra. Intraurethral pellets and intracavernosal (penile injectable agents) are also available if oral medications fail. Various mechanical external vacuum pump devices are helpful also in patients who are comfortable with assisted devices. Penile revascularization surgery has mostly fallen out of favor due to poor outcomes in most patients. At this time, the only treatment available to patients who have not succeeded with any of the above are surgically implanted hydraulic penile prostheses. These surgeries are somewhat invasive but often effective.

Adipose derived stem cells have shown extraordinary promise in revascularizing cardiac tissue, ischemic limbs and other organs suffering damage from poor blood flow by regenerating small blood vessels as well as smooth muscle and nerves. We have evidence that adipose derived stem cells stimulate endothelial (small blood vessel lining) growth and improve penile blood flow in animal models. Early attempts have been made in human patients to improve erectile function using adult mesenchymal stem cells however results have been inconsistent. There is some evidence that results will be optimized if the transplanted stem cells are “activated.” The process of stem cell activation is usually a natural phenomenon  induced by inflammatory and ischemic events. However, chronic micro-vasculopathy may require tissue micro-trauma to induce cellular healing and angiogenesis. Controlled tissue micro-trauma can be induced using low intensity shock wave treatment of the penis has been used successfully for years for penile pain associated with Peyronies disease. In 2012, a publication in the Journal of Urology (See Citation) provided evidence that shock wave technology alone can significantly improve erectile function in comparison to placebo treatment.

The Journal of Urology Volume 187, Issue 4, Supplement , Page e606, April 2012

DOES LOW-INTENSITY EXTRACORPOREAL SHOCK WAVE THERAPY HAVE A PHYSIOLOGIC EFFECT ON ERECTILE FUNCTION? SHORT-TERM RESULTS OF A RANDOMIZED, DOUBLE-BLIND, SHAM-CONTROLLED STUDYVardi, Appel, Kilchevsky, Gruenwald

At Cell Surgical Network, we have designed a protocol to deploy extremely high numbers of adipose derived stromal vascular fraction (rich in stem cells and growth factors) into the penile corpora cavernosa in conjunction with low intensity shock wave therapy in an effort to stimulate vascular endothelial repair and angiogenesis. This represents an attempt to achieve improvement erectile dysfunction in patients with vasculopathy and Peyronies disease.