Sertleşme problemiErektil disfonksiyonun tedavisinde klinik stratejiler.

Erektil disfonksiyonun tedavisinde klinik stratejiler.*

  • Cerrahi yöntem (Penis Protezi, Damar Cerrahisi)

  • Ağızdan ilaç uygulamaları 

  • İntrakavernöz vazoaktif ilaç enjeksiyonu tedavisi 

  • Vakum  cihazları

 

Sınırlı veriye sahip tedaviler

  • Testosteron replasmanı

  • Bitkisel Tedaviler 

 

Yeni klinik araştırma olarak düşünülecek tedaviler

  • Ekstrakorporeal şok dalgası terapisi (ESWT) 

  • İntrakavernosal kök hücre tedavisi ***

 

*Erectile Dysfunction: American Urological Association Guideline

***

Five studies have evaluated the effects of ICI stem cell therapy for ED. Bahk et al. (2010) reported on the effects of umbilical cord stem cells administered ICI to seven men with type 2 diabetes and ED who were scheduled to have prosthesis surgery. A control group of three men was administered saline. Measures included the SHIM, SEP questions 2 and 3, a global assessment question and an erection diary. The control men did not experience change in erectile function during the study. At two months post-procedure, six of seven stem cell-treated men reported the return of morning erections and increased penile hardness. Two men were able to achieve an erection sufficient for intercourse with the addition of 100 mg sildenafil. By nine months post-procedure, however, only one man was able to have intercourse with the use of sildenafil.   

Garber and Carlos (2015) reported on six men with type 2 diabetes who were awaiting prosthesis surgery; men received stem cells from adipose tissue. By three months post-procedure, five of six men recovered morning erections and maintained them for approximately four months. Rigidity increased but was insufficient for intercourse. With use of a PDE5i, four men were able to have intercourse for approximately nine months.  

Yiou et al. (2016) reported findings from a one-year dose-escalation study in which 12 men post-RP received one of four doses ICI of bone marrow cells. Measures included the IIEF, the EHS, and color DUS. At six months, significant improvements with the use of medications (unspecified) were reported in the IIEF-EF (baseline 7.3; six months 17.4) and the Intercourse satisfaction subscale (baseline 3.9; six months 6.8). The authors noted that findings were similar at 12 months post-procedure and that greater effects were associated with higher doses. Overall, 9 of 12 men were able to have intercourse with the use of medication. In addition, ultrasound parameters (i.e., basal PSV, 20-min PSV) demonstrated significant improvements.  

Haahr et al. (2016) reported findings from a six-month study of 17 men post-RP administered stem cells obtained from abdominal fat. Eight of 17 men recovered sufficient erectile function to complete intercourse by six months post-procedure. The treatment did not benefit incontinent men, but SHIM and EHS scores improved significantly among continent men.  

Levy et al. (2016) used placental matrix-derived stem cells in eight men with ED who were able to have intercourse pre-treatment with the use of ICI medications.Post-procedure, three men were able to achieve erections without medications and four were able to have intercourse using low-dose PDE5i. However, two men were lost to follow-up during the study, leaving it unclear whether effects were sustained. 

The Panel interpreted these data to indicate that stem cell therapy is a nascent technique in need of more rigorous study before widespread use as a reliable ED therapy.  

Erectile Dysfunction: American Urological Association Guideline

https://www.auanet.org/guidelines/erectile-dysfunction-(ed)-guideline#x8064 

Erectile Dysfunction: AUA Guideline (2018)

Published 2018

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