Erectile dysfunction – Erectile disorders

What is erectile dysfunction (ED)?

Erectile dysfunction is erectile dysfunction. The affected patient complains that his erection does not have the usual strength, lasts too short or does not come about as desired.

Erectile dysfunction is a common condition

Occasionally, younger patients are affected, but the frequency increases from the age of 40. In the age group from 50 years onwards, 15% of men suffer from it, and from the age of 60 years onwards, it is already over 25% of men.

What is the right course of action for a patient with erectile dysfunction?

A medical check-up is always a good idea. Erectile dysfunction can have various causes, which can be identified with a patient interview, a blood analysis and an examination. I strongly advise you not to buy potency pills on your own from dubious websites without having done research on the cause of the erectile dysfunction. On the one hand, the parallel import of prescription drugs is illegal, on the other hand, you don’t know what the pills even contain. Moreover, combining this group of medicines with certain other commonly prescribed drugs is even dangerous.

Erectile dysfunction can be a warning signal

Erectile dysfunction is most often an expression of vascular disease. Diabetics are particularly often affected. Risk factors for vascular disease such as high blood pressure, elevated cholesterol and sugar levels should be examined. If one vascular area – in the case of erectile dysfunction it is the erectile tissue – is diseased, another vascular area, e.g. the coronary arteries, could also be affected. If necessary, a consultation with a heart specialist is recommended.

Other causes are various medications, but alcohol or substance use (cannabis, amphetamines) can also contribute to erectile dysfunction. Finally, hormonal disorders should not be forgotten, e.g. hyperthyroidism or hypothyroidism. In younger patients, a psychological factor can also be the trigger.

The correct clarification of erectile dysfunction

On the one hand, this includes a medical consultation, on the other hand, a blood analysis and, if necessary, further examinations. With the help of the questionnaire IIEF (international index of erectile function), the severity of the erectile dysfunction can be assessed. The blood analysis includes the measurement of various hormones, fasting glucose, cholesterol and PSA.

Choosing the right treatment

The first-line therapy is the prescription of PDE5 inhibitors, i.e. the well-known drugs Viagra^®, Levitra^® and Cialis^® or their generics. When prescribing, however, attention must be paid to the patient’s other medication, as interactions between the drugs are possible.
The next alternative is the use of prostaglandins, e.g. the MUSE^® or Caverject^® system. These drugs cause an erection that occurs at different speeds or lasts for different lengths of time, depending on the preparation.

An alternative to this is treatment with shock waves and PRP (platelet-rich plasma). Shock wave therapy has been used in medicine for a long time, e.g. for tendonitis or calcification of the tendons. But it also has regenerative power for the blood vessels.

The PRP is obtained from a collection of the patient’s own blood. Centrifugation separates the red blood and the blood plasma, which is then injected into the erectile tissue of the penis. The injection is far less painful than the patient imagines.

For both therapies, the positive effect on erection has been proven in studies. However, there is still no internationally recognised application protocol. I rely on the experience of my medical colleague in urology, Dr. med. Altwegg from Geneva (www.policlinique-helvetique.ch), from whom I learned the theoretical and practical basics of the therapy. His patients travel from all over the world to benefit from his expert knowledge of erectile dysfunction.

Patients with an intermediate to higher score on the IIEF (international index of erectile function) have a good chance of success with the treatment protocol below. The positive effect should last for a few years, but not forever. However, if a patient suffers from very pronounced erectile dysfunction, treatment is not advisable. The chances of success would unfortunately be low.

The treatment protocol with PRP and Shockwave

A full treatment protocol lasts 9 weeks and includes 12 sessions of shock wave therapy and individual PRP injections. Treatment with shock wave therapy alone is possible, but the combination with PRP promises more success.

The single session with Shockwave takes about 20 minutes. The preparation of the PRP requires a normal blood sample of 30ml, the centrifugation takes a few minutes, the injection is also done in a few minutes.

What side effects are to be expected?

Shock wave therapy is painless and only causes noticeable vibrations. PRP injections can cause haematoma (bruising). Caution is advised when taking anticoagulants (Marcoumar^®, Xarelto^®, Eliquis^®, Lixiana^®).

What are the costs for a complete treatment? Which part is covered by the health insurance?

The consultations and any laboratory analyses are covered by the basic insurance. The patient’s share of the costs is calculated according to their individual insurance conditions regarding their deductible and excess. However, the shock wave therapy and PRP injections are at the patient’s expense because there is no recognised treatment protocol for them yet. The total costs are around CHF 4300.

Is the treatment with Shockwaves and PRP suitable for every erectile dysfunction?

No. This therapy is suitable for erectile dysfunction caused by vascular disease. If, on the other hand, the erectile dysfunction is the result of a spinal trauma or a hormone disorder, it has no positive effect for the patient.

Does the treatment with shock waves or the PRP injection lead to an extension of the penis?

Some patients state that there has been a slight increase in the length of the penis. However, the aim of the treatment is not to increase the size of the penis. This would require a surgical intervention. At best, a slight increase in length could be achieved through shock waves and PRP. In any case, PRP improves the blood flow to the erectile tissue, which has a positive effect on the functioning of the penis.