Modern Aproach To The Treatment Of Erectile Dysfunction

Substantion The Relevance Of The Theme

Sexual sphere of man is an integral part of his overall health and significantly determines the quality of life and psycho-emotional well-being.

An adequate erection in the structure of the sexual cycle and is the main prerequisite for conducting sexual intercourse. In 2009, at the Congress of the International Society for the Study of Sexual Health (Paris), erectile dysfunction (ED) is defined as the inability to achieve and (or) maintain an erection sufficient for satisfying sexual activity, if these disorders are observed at least 3 months.

The average global incidence of erectile dysfunction for ages 1-10 and 40%, 40 to 49 years – 2-15%, 50 to 59 years – 20-40%, from 60 to 69 years – 40-50%, and the group older than 70 years reaches a maximum – up to 75%. According to the calculations J.B. McKinlay (2000), approximately 152 million men worldwide suffer from ED. It is expected that this figure over the next 25 years will double, reaching a value of 322 million patients. Smoking, excess food, leading to obesity, metabolic syndrome – the main factors of ED risk. Most patients have related cardiovascular and endocrine systems as atherosclerosis and diabetes, which in turn vitiate ED. Antihypertensive drugs also have a negative effect on sexual function of patients. Another important factor is a social problem: one in three divorced man the cause of the collapse of his marriage, he says the presence of ED. Stress, quarrels, dissatisfaction with life in general, and, as a consequence of all this – the sexual violation. Sexual dysfunction in men cause the development of sexual dysfunction in women, leading to complications range of sexual problems.

Recently, a new promising method for the treatment of erectile dysfunction has been opened (erectile disfunction – ED). It is called lower intensity shock wave therapy (shock wave therapy). Erection problems may be related to many factors: psychological and neurological disorders, stress, dissatisfaction with life, smoking, obesity, metabolic syndrome. But this technology is for people, the cause of erectile dysfunction which has become associated diseases such as diabetes and cardiovascular disease.

HISTORY OF DEVELOPMENT OF ESWT

  1. Gutersohn et al. (2000) demonstrated in vitro stimulation of angiogenesis when exposed to shock waves of low intensity tissue. Later, in 2004, T. Nishida et al. observed increased expression of a vascular growth factor (VEGF), and the corresponding vascular factor receptor (Flt-1) in cultured endothelial cells of human umbilical vein (Fig. 1).

The maximum level of VEGF expression was observed when exposed to the shock wave with the intensity of 0.09 mJ / mm2, which corresponds to approximately a tenth of the energy used for lithotripsy in treating urolithiasis. In 2005, S. Mariotto et al. in vitro showed that low-intensity shock wave increases II nitric oxide (NO).

Low-intensity shock wave therapy (NUVT) through stimulation of vascular growth factor and its receptors and increase the production of nitric oxide won versatile clinical applications: in cardiology for the treatment of coronary heart disease; in traumatology – to accelerate the consolidation of fractures, treatment of epicondylitis and heel spurs. The effects of low-intensity waves are also used in surgical practice to accelerate epithelialization neurotrophic ulcers in patients with diabetes mellitus, as well as reducing periods of engraftment of transplanted skin graft.

Theoretical data, experimental studies and clinical observations suggest that NUVT will increase the production of nitric oxide, VEGF and Flt-1 receptors, thereby activate angiogenesis in the cavernous tissue and, consequently, improve sexual function of patients suffering from vascular form of ED. The first clinical studies have shown promising results of this assumption.

EXTRACORPOREAL SHOCK WAVE THERAPY (ESWT)

EXTRACORPOREAL SHOCK WAVE THERAPY (ESWT)

Extracorporeal shock wave therapy refers to a type of non-invasive procedures for the treatment of erectile dysfunction, when a special device formed special shock waves sent urologist in a specific area of the penis.

As a result of the shock of the packed cavernous bodies of the penis softening fibrosis (scar deformation in the cavernous bodies, resulting from impaired blood flow), resulting in a softening of the vessel walls due shock waves. This in a man run their own mechanisms for its recovery by the appearance of new, small blood vessels in the cavernous bodies of the penis, contributing to the improvement of blood circulation, as well as oxygen saturation of the penis. The newly formed small blood vessels and arteries develop and carry more oxygen in the corpora cavernosa, which in turn improves the functioning of blood vessels of the penis.

However, it should be noted that in the treatment of impotence by shock wave therapy, the penis does not change their original natural size, and changing only the density – a man’s penis to become harder and more viable to a natural erection and ejaculation.

Medical examinations, which often include ultrasound (Doppler) of the penis, by doctors, urologists in the treatment of impotence, confirm the effectiveness of ESWT method – after undergoing the treatment course shocks the blood flow inside the penis increases at least 5-10 times.

That is why, at the Congress of the European Association of Urology, held in Madrid in March 2015, highly skilled doctors, urologists from around the world have adopted specific recommendations on the use of extracorporeal shock wave therapy as a monotherapy for the treatment of erectile dysfunction. Either as a significant, additional physiotherapy technique in treatment of impotence using pharmaceuticals.

THE EFFECTIVENESS OF THE TREATMENT OF IMPOTENCE BY ESWT

The main effects of the treatment of extracorporeal shock wave therapy urologists include:

  • resumption of morning erections: men do not experience it in the last 3-5 years after the passage of 2-3 procedures;
  • erection manifestation not only in the morning, but in the evening (night) time – after passing 4-5 x ESWL procedures;
  • complete physiological recovery intercourse after 5-6 th procedure in patients who could not fully carry out its mean penile flaccidity.

This medical practice of our doctors proves that the effectiveness of treatments for impotence treatment shock waves does not depend on age or on the severity of the problem with which the patient came to the reception to the urologist.

DURATION OF TREATMENT OF IMPOTENCE BY UHT

Generalized urological practice physicians around the world shows that, for the treatment of impotence shock-wave method is best suited three-month course, in the course of which the first three weeks is held 6 sessions. Within each procedure, a doctor treats a patient 6 zones sexual member. This is followed by a 3-week break, after which the remaining six procedures are carried out over the next three weeks. Experience urologists shows that even after the passage of half of treatment 100% of men noted a significant effect, and a good result from the treatment. Undoubtedly, the number of procedures and time-frames are selected individually urologist, in each case as a possible increase in the course of procedures, and their decrease, depending on the patient’s desired results. Long-term effect of a 3-month course of treatment of extracorporeal shock wave therapy is retained for one year (subject to the recommendations of the attending physician), then you want to re-pass the course of procedures.

CONTRAINDICATIONS TO ESWT COURSE

The major limitations in the application of methods of extracorporeal shock wave therapy is the presence of tumor processes in the body of the patient:

  • tumors of the skin, in the projection of the penis and scrotum;
  • prostate cancer.

If this development is not available to you, you can follow some tips to prevent and treat this disease. You need to change the way of life, to get rid of bad habits, doing physical exercise, increases blood flow to organs and tissues, as well as do not forget about the benefits of fatty acids.

CONTRAINDICATIONS TO ESWT COURSE