The definition of erectile dysfunction (ED), also known as impotence, is the recurring or consistent inability to acquire or sustain a penile erection of sufficient rigidity and duration for sexual intercourse. Surveys show ED to be present in 16% of the male population with an increasing incidence with age. Approximately 8% of men age 20-30 experience ED while 37% of men age 70-75 suffers from ED.
The purpose of this paper is to help readers gain a greater understanding of the use of adult stem cells for ED. We also want to offer a framework for evaluating if stem cell treatment should be considered an option for you or your loved one. The paper covers the following:
Feel free to skip to sections that provide information that is helpful to you. For more information including definitions and descriptions of ED visit:
Frequently Asked Questions
A: Erectile dysfunction can result from a number of underlying causes. Normal erectile function requires intact vascular and neurologic function and proper psychogenic stimulus. Interruption of any of these areas can result in erectile dysfunction. Common causes are vascular, neurological, hormonal or endocrinologic, and medications (pharmacologic).
There is strong association with cardiovascular disease. Many view erectile dysfunction as an early warning sign for heart attack or stroke disease. Men over age 45 or with significant risk factors (family history, smoking, high cholesterol) should discuss their erectile dysfunction with their primary physician. A cardiovascular evaluation may be appropriate. Other evaluations such as a complete history, medication review, hormonal testing and genital examination may also be considered. Proper evaluation can lead to effective treatment in most men. For many men who do not find effective treatments, adult stem cell therapy may be a good option. For more complete information on the causes of erectile dysfunction see:
A: Typically, the first step in treating erectile dysfunction is determining the underlying cause. This may involve different types of testing such as: a medical history, lab work, cardiac stress testing and others. Following the evaluation, the commonly used treatment options are:
1. Medications such as Viagra (sildenafil) and Cialis (tadalafil). These are known as phosphodiesterase inhibitors. These work well in many men. Unfortunately, some men have side effects with these medications and others do not respond. Men taking nitroglycerin type drugs cannot use phosphodiesterase inhibitors.
2. Drugs injected into the penis such as Caverject (alprostadil) are the second choice. These drugs work for many men, but others dislike the need for a shot. These drugs are also available as a penile suppository (insertion up the urethra).
3. Vacuum assisted erection devices. These devices use a vacuum pump to assist erection. They are frequently coupled with a ring that fits at the base of the penis to help maintain the erection. Typically, no more than half of men are satisfied with the long term use of these devices.
4. Penile prosthesis is an option for men who do not respond to or are not satisfied with the above options. Several types are available.
5. Testosterone replacement therapy has been shown to be effective in the presence of low testosterone levels. The effectiveness of testosterone alone may decrease over time for men with low testosterone levels. For men with normal testosterone levels, adding to the levels is rarely helpful for erectile dysfunction.
6. Other treatments are used from time to time that range from pills to vascular surgery.
To learn more about treating erectile dysfunction please see:
Using the above options is effective for the majority of men. If you are a person doing well using these options, this might not be the right time to consider adult stem cell treatment. For those who have not responded or who do not like the options available for them, adult stem cell therapy is an option for them.
A: Stem cells are special cells in our bodies that have two important characteristics:
1. Stem cells have the ability to replicate. In other words they can make new copies of themselves. Because of this ability, an infinite number of copies can be made from the same cell.
2. Stem cells also have the ability to become other types of cells. A good example of this is that research labs have used fat derived stem cells to make cartilage muscle, skin and bone cells. This ability means that in theory the transformed can make an infinite number of the new cell type.
Stem cells can come from a number of sources including embryos, umbilical cord blood and adult cells. Adult stem cells come from adult individuals, not embryos or umbilical cord blood. Stem cells obtained from mature adult tissues are referred to as adult stem cells. Adult stem cells are believed to have the potential to become any type of cell.
The two most commonly used sources of adult stem cells are fat and bone marrow.
Adult stem cells from fat are called adipose derived adult stem cells. For most purposes, stem cells from fat are easier to obtain and more abundant than from other tissues. For more information on stem cells visit: https://stemcellrevolution.com/
A: Harvesting adult stem cells from fat is very safe. The procedure has little discomfort and fairly easy recovery. First an area such as the stomach or leg is picked to remove the fat. We then take you to the procedure room and sterilize the area. A local anesthetic is then injected into the area. Fat is suctioned using special syringe and cannula. Typically we suction about 50 ml (about 1 1.2 oz.) of fat.
Swelling and bruising is common following the procedure at the harvest site. Swelling and bruising typically resolves within 2-3 weeks after the procedure. Most patients receive a prescription for pain medications for use as needed. We give a dose of antibiotics before the procedure but no antibiotics are needed afterwards.
Nest we take the harvested cells and use a centrifuge and incubator to do some simple processing. The processing isolates the adult stem cells from the other fat cells. The final product is called Stromal Vascular Fraction (SVF). SVF obtained from fat can contain up to about 25 million adult stem cells from 50 ml of fat. SVF also contains a large amount of growth factors. Growth factors are chemical “text messages” our cells use to communicate with each other. After we have obtained the SVF, the next step is to deploy the SVF for your erectile dysfunction.
A: When we use the adult stem cells/SVF (see above for a description of Stromal Vascular Fraction –SVF) to treat a disorder we refer to it as deployment. The typical deployment for erectile dysfunction is into the shaft of the penis using a small needle. We add local anesthetic to help with the discomfort.
We do some special treatments to the penis using a device called Extracorporeal Shock Wave Therapy (ESWT) before and after deployment. The ESWT appears to enhance the response to adult stem cell/SVF deployment.
A: Very large versions of Extracorporeal Shock Wave Therapy (ESWT) devices are used widely for the treatment of kidney stones. These devises deliver a shock wave to the body that breaks apart the kidney stone. Much smaller versions of ESWT have been used for orthopedic injuries, scar improvement and even treatment of cellulite on women’s legs. The small device has been used by itself for ED and a related disorder called Peyronie’s Disease (click here to read about adult stem cells and ESWT for Peyronie’s Disease). The treatment is most similar to a deep massage.
We give three ESWT treatments about every other day for about a week. Following the second treatment we deploy the adult stem cells/SVF as described This combination of adult stem cell/SVF deployment and ESWT treatment is the most advanced protocol for erectile dysfunction.
A: Currently the treatment group is not large enough to give a conclusive answer to this question. It is important to note that the Food and Drug Administration (FDA) has NOT approved the use of adult stem cells/SVF for any disorder. This includes the use of stem cells/SVF for erectile dysfunction. Fortunately, we have enough early experience to talk about trends in therapy. The number of patients treated increases weekly, so the total depends on when you are reading this article (initial writing July 2013). Thus far, all patients treated have seen an improvement in erectile function. No patient has reported erectile function inadequate for sexual intercourse. With some disorders for which stem cells are used require repeat deployments in a few months. It is too early to tell if repeat deployments will be recommended for erectile dysfunction.
We hope we have answered the majority of your questions. If you have others or wish to schedule a consultation please call: 214-420-7970.