Erectile dysfunction is defined as the sustained inability to achieve and maintain an erection sufficient to allow satisfactory sexual intercourse. Therefore, the first diagnosis is made by the patient himself when he becomes alarmed when he is unable to achieve sufficient rigidity to penetrateIt is a very common condition affecting 152 million people worldwide.
In the West there are 25-30 new cases per 1000 inhabitants per year, and in Spain alone it is estimated that there are between 1.5 and 2 million men with erectile dysfunction. However, only 16.5% of those affected consulted a doctor for this problem (EDEM study 1999).
In this EDEM study (which, although dating from 1999, is still prevalent) the following percentages of EDs by age group were found:
25-39 years old ..... 8.6%
40-49 years old ..... 13.7%
50-59 years old ..... 24.5%
60-70 years old ..... 49%
Erectile dysfunction is found in all age groups. In young people, the most frequent cause is psychogenic. The age group with the highest incidence of organic causes is found in men between 50 and 70 years of age (75%).
Sentinel symptom - Target organ
It often happens that because the patient consults for an alteration in his erection, we find in the study alterations in his blood pressure, coronary problems, kidney or liver disease, or from simple anaemia to tumours. Thus we say that erectile dysfunction behaves as a warning symptom of other diseases, or that the penis is a "target organ".
Diagnosis
The diagnostic process involves a series of steps to elucidate whether the problem is organic, psychological or mixed. It requires:
- Examination of the patient and his penis
- General and hormonal analysis
- Conducting evaluation tests
- Nocturnal Erection Recording (RigiScan)
- Study of penile circulation (Doppler ultrasound),
Among the organic causes, hormonal causes, the presence of a systemic disease, neurological problems and the toxicity of certain drugs must be ruled out.
Vascular involvement
It is the main cause of erectile dysfunction. The vascular processes that mainly trigger ED are:
- Primary vascular disease
- Accidental arterial injuries
- Arteriosclerosis and cholesterol elevations (hyperlipaemia): They produce obstructive arterial lesions at the level of the penile arteries.
- Diabetes mellitus: is a vascular risk factor that causes alterations in the mechanisms of blood supply to the penis during erection.
- Arterial hypertension: causes a decrease in the percentage of smooth muscle fibres and an increase in fibrosis of the penis.
- Smoking
Neurological involvement
- Neurological diseases
- Neurotoxic
- Accidents
- Radical surgeries (surgical treatment for prostate cancer)
Treatments
In a case of systemic disease, management of that disease and its improvement may help the patient to improve his erection.
The cessation of intoxicants (mainly tobacco and heroin, but in general all of them) always improves the deteriorated erection.
Of course, if the patient has a hormonal problem, hormone therapy is indicated.
In a case with a psychological cause, psychotherapy will help.
Injections of papaverine into the penis have been used since the 1980s to produce erections, and in the 1990s Prostaglandin E1 displaced Papaverine as it had far fewer complications. It has been marketed since 1994 as Alprostadil (Caverject) and is now available as a urethral suppository (Muse).
Since 1998, when the PDE-5 inhibitors appeared, great strides have been made in the treatment of erectile dysfunction with oral medications. The introduction of Sildenafil (Viagra) and later Tadalafil (Cialis) and Vardenafil (Levitra) and more recently Avanafil, Udenafil and Mirodenafil, have meant a very important advance in the treatment of this disease. All these drugs belong to the same family, Phosphodiesterase 5 inhibitors, and their effect consists of making the chemical mediator of erection, Nitric Oxide, act in greater quantities and for longer periods of time. They differ in their speed of action, duration in the body, and the amount needed for them to take effect.
The overall response rate to PDE5 inhibitors is 65-70 percent according to the authors.
In addition to non-response, or unsatisfactory response, Inhibitors can cause side effects:
- Tachycardia
- Alteration of blood pressure
- Headache
- Nasal, facial or eye congestion
- Gastric discomfort
- Myalgias (muscle aches)
And they are incompatible with drugs that dilate the coronary arteries (nitrates and nitrites), and with some drugs for hypertension and antiretrovirals (AIDS treatment).
When treatments fail or are not tolerated, we are left with surgery (prosthesis implant) as a solution. It is a good and definitive alternative for those men who do not respond or who cannot take the existing medicines.
What are the benefits of shock waves?
Shock waves (high intensity) have been used since the 1980s for the treatment of urinary tract stones (EXTRACORPOREAL SHOCK WAVE LITHOTRIX).
Low intensity shock waves have already been demonstrating a powerful ANTIFIBROTIC effectiveness, being used in Medical Physiotherapy for the treatment of joint injuries and fibrous degeneration of ligaments with great success.
Subsequently, improvements in the vascularisation of the heart muscle have been demonstrated, first in experimental animals and then in humans. This effect of low-intensity shock waves is called NEOANGIOGENESIS, i.e. the appearance of new circulation after the destruction of fibrous tissue.
Low intensity shockwaves in erectile dysfunction
Most of the problems in the functioning of the erection mechanisms are due to circulatory deficiency on the one hand and sclerosis of the small blood vessels on the other, as well as progressive fibrosis of the corpora cavernosa.
This fibrosis - sclerosis and circulatory failure occurs in diabetes, arterial hypertension, cholesterol dyslipidaemia and other arteriosclerosis. Also in diseases of unknown origin such as cavernous body fibrosis or Peyronie's disease.
Therefore, the application of low intensity shock waves will bring a significant improvement by fighting fibrosis and sclerosis, and by producing a new vascularisation.
The treatment will produce its effects progressively over time, with improvements being observed between 1 and 3 months after the application of Shock Waves. This treatment does not exclude the use of oral medication to improve erection. It can be applied while the patient continues to take his oral treatment. The aim is for the patient to either stop needing it, or to require a lower dose or to take it more frequently. In other cases, patients who do not respond to these drugs are able to respond to them, thus avoiding the need for intervention.
The application of the treatment is painless and there are no known side effects associated with the administration of low intensity shockwave therapy.