Impotence

Erectile dysfunction (ED) is one of the most common diseases in adult men. By 2025, 322 million men worldwide will be affected by ED, with a reported prevalence rate of 48%. The prevalence rate increases with age, from 5% of men aged 20-39 to 70% of men aged over 70. There are many reasons for ED, including psychological and organic reasons. The performance of ED is due to the decrease of penile artery blood flow, neurological and endothelial dysfunction, and the inability to achieve or maintain erection to obtain satisfactory sexual performance. ED greatly reduces the quality of life of men and their partners, and is usually associated with complications such as diabetes and cardiovascular disease. For men, nothing can show their confidence faster than achieving or maintaining a satisfactory erection. The impact on the sexual life and interpersonal relationship of elderly men cannot be underestimated, although some drugs can help elderly men achieve or maintain erection; But their effects are temporary. These drugs may have serious adverse reactions, including the risk of heart attack and stroke. People have always hoped for an effective natural method to restore men's sexual health. The so-called "Romeo" treatment technology in foreign countries is the related treatment with Platelet Rich Plasma (PRP). This fast, safe and complete natural therapy can provide immediate and lasting improvement for men's sexual behavior. It can increase blood flow, improve erection, increase sensitivity and endurance. After injection of PRP, the penis is firmer and stronger, the erection frequency is faster, and the erection time is longer. Some people are not ill, and they inject PRP into their Ding Ding to enhance their "masculinity" and make Ding Ding from good to excellent. It is hoped that the middle-aged and old people can return to their biological age of 25 years old, and can revive the momentum of their biological age of 25 years old. There is no doubt about the effect of PRP treatment on the decline of sexual ability caused by aging. In patients with erectile dysfunction caused by diabetes and prostate diseases, injection of PRP also has an effect. Swift won the US patent for PRP treatment of erectile dysfunction in 2012. 1、 It sounds like the gospel of ED patients! So what exactly is PRP? Platelet rich plasma (PRP), referred to as PRP, is the concentration of autologous platelets after centrifugation of autologous whole blood. The number of platelets is more than three times higher than that in whole blood. PRP contains high concentration platelets, which are generated by bone marrow hematopoietic cells and exist in human blood. Platelet rich is not a common body fluid. It is a growth agent rich in a large number of growth factors, such as platelet derived growth factor (PDGF), transforming growth factor - β (TGF - β), insulin-like growth factor (IGF), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), etc, The secreted growth factor adheres to the surface of damaged cell membrane, activates cell membrane receptors, and stimulates normal gene sequence expression of cells. This step is regeneration. It can accurately self locate to the damaged part, and can promote the regeneration of cells and tissues from different aspects, thus accelerating the repair of damaged tissues. II History of PRP research and application KingsleyCS published the concept of platelet rich plasma in Nature in 1954. ChildsCB et al. (1982) found that plasma contains growth factors from platelets, which can promote cell growth. GibbleJW et al. (1990) reviewed and analyzed the characteristics of hemostasis and adhesion of platelets and their application in surgery. Since then, PRP has been widely used in orthopedics, sports medicine and other disciplines. At present, Harvard University and several major pharmaceutical companies have successively launched commercial PRP tools, and the application prospect of PRP is broad. Since its introduction in 1987, the application of PRP in medical treatment has been growing steadily, and its application in orthopedics, otorhinolaryngology, neurosurgery, dermatology, and cardiology has also been reported. Thoracic surgery, dentistry, and now urology. Platelet rich plasma (PRP) therapy trusted by NBA superstars. In recent years, platelet rich plasma therapy has become a common method for NBA players to treat injuries, especially knee injuries. The earliest retired superstar Kobe Bryant, active Stephen Curry and Dwight Howard all received platelet rich plasma treatment. Online celebrity Kardashian broadcast live on the variety show that she received "Vampire Therapy" beauty treatment. In the picture, Kardashian received the treatment of autologous serum which was extracted from her own blood and then injected back to her face. III How can PRP treat ED? PRP is equivalent to various growth factors in autologous blood. The required platelet growth factors and fibrin are extracted from the blood and injected into the penis where we need them to stimulate the self repair and regeneration function of the injection site, which will play a role in regeneration and repair. Platelet rich plasma (PRP) is an exciting biotechnology. PRP acts on cells, increases the number of cells (mitosis) and stimulates the inward growth of blood vessels (angiogenesis), thereby promoting healing. This is because platelets not only have hemostatic properties, but also contain rich growth factors (GF) and cytokines, which can affect inflammation, angiogenesis and cell proliferation. These GFs and cytokines are released after platelet activation. The most important GFs include vascular endothelial GF (VEGF), fibroblast GF (FGF), platelet-derived GF (PDGF), epidermal GF (EGF), hepatocyte GF (HGF), transforming GFbeta-1 and beta-2 (TGF-b1/2), insulin-like GF (IGF − 1, IGF-2), interleukin 8 and matrix metalloproteinase 2,9. It is speculated that PRP injection may change the key pathophysiological mechanism of ED through anti-inflammatory, repair, neuroprotective and neurotrophic effects. EpifanovaMVetal's SexMedRev literature in 2019 showed that PRP realized its therapeutic potential through the regeneration of endothelial cells, smooth muscle cells and connective tissue. Injection of PRP can promote the development of new penile blood vessels and improve penile circulation. It can also promote the repair of damaged nerves and the regeneration of nerve type carbon monoxide synthase, and obviously promote the nerve regeneration of damaged cavernous nerves and the recovery of their erectile function. Matz et al found that platelet rich fibrin matrix injection is a well tolerated, safe and feasible treatment for patients with ED, peyronie disease (pd) and stress urinary incontinence. They reported that after injecting platelet rich fibrin matrix, the international index of erectile function score increased by an average of 4.14 points. Published in 2021 by Poulios et al., it is the highest quality study on the injection of PRP into ED so far. They randomly selected 60 men to receive 10 ml of PRP or placebo (n=30 for each group). The preparation of PRP includes collecting blood samples in a 60ml syringe containing 8ml anticoagulant. Then, the blood sample was processed through the FDA approved autologous platelet separator (Magellan autologous platelet separator) to generate about 10ml of PRP. This system is used because it is considered to produce high quality PRP. Apply a penis tourniquet around the penis root and give about 5ml of PRPICI. Release the tourniquet after 20 minutes. Patients were evaluated 1, 3 and 6 months after injection. The main results were the proportion of men who reached the "minimum clinically significant difference (MCID)" in the International Erectile Function Index (IIEF5) from baseline to 6 months, and the safety of injection. They found that 69% of men in the PRP group reached MCID at 6 months, while 27% of men in the placebo group reached MCID (risk difference was 42%, P<0.001). Statistically significant results were also obtained during the 1-month and 3-month follow-up periods. Zaghloul et al. included 48 ED patients who did not respond to oral PDE5. Among them, 24 patients with diabetes were treated as diabetic ED group, and the other 24 patients without diabetes were treated as nondiabetic ED group to evaluate the therapeutic effect of intracavernous injection of PRP. During the study period, all patients took tadalafil 5mg and vardenafil 20mg daily as required, and received intracavernous injection of PRP at week 1, 5 and 9. The results showed that the erectile stiffness score and IIEF-5 score increased in both groups; The diabetic ED group was further divided into good control group, general group and poor control group according to the control of diabetes. Compared with the poor control group, the effect of intracavernous injection of PRP on patients with good control of diabetes and general group was more significant. The researchers therefore believe that intracavernous injection of PRP can improve the IIEF-5 score of patients with ED who do not respond to on-demand oral PDE5 and may improve the therapeutic effect of PDE5. Especially for ED patients with diabetes well controlled, the therapeutic effect may be better, but more detailed research is still needed in the future to determine the best treatment scheme and preparation method of PRP for such patients, And longer follow-up after treatment to observe the possible adverse reactions of patients. In the guide of the Canadian Urological Association: ED, it is said that regenerative therapy is aimed at restoring the structure and function of erectile tissue and providing "cure" for the disease process, rather than just treating ED symptoms. Pre clinical and early human studies have explored regeneration methods for the treatment of ED, such as stem cell therapy (SCT), platelet rich plasma (PRP). However, these options have not yet been approved for use outside clinical trials and are still in the experimental stage. 4、 Compared with traditional treatment methods, what are the advantages of using PRP to treat diseases? In the past 20 years, although the treatment methods of erectile dysfunction (ED) have been greatly enriched, including oral PDE5i drug treatment, transurethral administration of prostaglandin E, injection of vasodilator into the cavernous penis, vacuum negative pressure device for erectile dysfunction and implantation of penile prosthesis, these treatment methods have good efficacy and safety, but most of them are still "on-demand" Treatment, and the effect can only be maintained for a short time. The next step in the study of ED treatment is to find a treatment method that can enable patients to obtain autonomous living ability. In this direction, although research in stem cell therapy, gene therapy and other fields has been ongoing, the work of curing ED still has a long way to go. Therefore, a new and effective treatment concept and method are needed to have a lasting effect on spontaneous erectile function. PRP is self (obtained from your own body); Natural (different from the injection of synthetic hyaluronic acid skin filler, for example) and non antigenic (does not stimulate the immune response). Platelets and various growth factors in PRP accelerate the process of tissue recovery and achieve the function of repairing damaged tissues through self physiological regulation and repair. The effect of PRP is obvious, safe and lasting; Adequate sources; The treatment range is wide. PRP is a fundamental treatment method, which activates the natural healing process of human body and participates in the regeneration process of damaged tissues. V Is there any side effect of PRP treatment? There must be side effects. As long as there is trauma, there will be side effects, such as infection, bruising, redness, and local swelling, which are all side effects of PRP injection. Therefore, it cannot be blind, and must be operated under sterile conditions. Kiki Sandford, an American molecular physiologist, said, "Even if the process is' safe ', there is still a risk of complications such as infection, even if the risk is very small. ① Infection: injection is also an invasive operation, which may lead to infection. Once infection occurs, it should be treated in a hospital in time. ② Stasis: generally 7-10 days will disappear by itself. ③ Redness: generally, it can disappear after 1-2 hours. ④ Local swelling and ecchymosis. So far, PRP treatment has not resulted in significant side effects or adverse reactions. 6、 Is the effect of injecting PRP to strengthen penis permanent? can't. The penis enhancement effect achieved by injecting PRP can last for 1.5 to 2 years. However, the process can be repeated to obtain more lasting results. 7、 PRP treatment process ① Prepare PRP for standby: after cleaning and disinfection, the doctor will draw 50ml of your blood from your elbow vein. This step is the same as the blood drawing during physical examination. It can be completed in 3-5 minutes with only slight pain. Centrifuge with 3000G centrifugal force is used for the primary and secondary separation of blood. This step is about 10-20 minutes, after which the blood will be separated into four layers of plasma, white blood cells, platelets and red blood cells. Using the patented PRP kit, we can extract platelet plasma containing high concentration of growth factor on the spot. ② Lidocaine cream is applied around the pre injection area; ③ PRP slowly injected into cavernous body; ④ Immediately aspirate the penis with negative pressure (so that PRP can be quickly distributed in the sponge body without flowing back into the peripheral blood circulation). ⑤ The penis is aspirated with negative pressure every day for eight weeks Compared with "Viagra", the advantages of PRP in the treatment of impotence are obvious. "Viagra" is currently recognized as a drug for the treatment of erectile dysfunction, but it needs to be taken every time before sexual life, and can only improve the hardness of a single erection, which cannot be reversed from the pathological level. It is the so-called "palliative treatment, not the root cause". PRP is symptomatic treatment based on pathology, which can completely "cure" erectile dysfunction and enhance erectile stiffness in a long time. In addition to psychological factors, all kinds of erectile dysfunction caused by physiological changes in the cavernous body of the penis can be treated through PRP. Therefore, it is suggested that patients can take PRP treatment as the main treatment, and take Viagra at the same time for auxiliary treatment, so as to achieve a better therapeutic effect. 9、 PRP combined with low-energy shock wave therapy in the treatment of EDGeyik compared the efficacy of low-energy shock wave therapy (Li SWT) alone and its combination with PRP in the treatment of ED. The results showed that Li SWT combined with PRP could prolong the latency of vaginal ejaculation, and the treatment was effective and safe. Saltzman et al. evaluated the safety and effectiveness of PRP combined with LiSWT in the treatment of mild to moderate ED patients, and prepared autologous PRP before starting the treatment. The treatment group received PBP injected into the sponge and LiSWT in vitro in the first week, only LiSWT in the second, third and fourth weeks, and PRP and LiSWT in the fifth week. The control group followed the same schedule, but only received placebo (saline) injection and fake LiSWT treatment. The results show that this therapy is feasible and safe, can promote angiogenesis, and is an effective choice for the treatment of ED. 10、 What are the precautions for receiving treatment? Generally, about 50ml of peripheral blood is required; The treatment time is about 30 minutes; No pain, slight pain; A course of treatment requires 3-5 injections, with the interval (2-3 months) depending on the condition of the disease; If hospitalized, it only takes 1-2 days; After treatment, normal activities can be resumed without special treatment, and life or work will not be affected basically; It is necessary to make an appointment for treatment in advance; Regular follow-up visits; Strict scientific and individualized functional rehabilitation training. Precautions after PRP treatment: ① Do not touch water at the treatment site 24 hours after treatment; ② Can go out to work immediately and normally; 2 days after operation, they can have sex; ③ Do not take aspirin within one week after treatment.

Neurogenic erectile dysfunction is a common cause affecting male sexual function. It brings discomfort and trouble to patients, and has a negative impact on their mental and emotional health. This article will introduce you to the symptoms, causes and treatment of neurogenic erectile dysfunction to help you better understand and deal with this problem

As the saying goes, men will want to do that as long as they have a breath, but now more and more men are still difficult to have sex even if they are not short of partners, because some parts of the body are always "disobedient" erectile dysfunction (ED), which means that the degree of penile erection cannot be achieved and/or it is difficult to maintain a satisfactory sexual life, and the disease duration is more than three months. In the past, men's "impotence" was generally referred to as "impotence". Chinese medicine calls it "impotence", and the symptoms are "impotence without lifting, lifting without firmness, firmness without too long". Its etiology is complex. Common clinical risk factors include diabetes (DM), smoking, hypertension, radical pelvic surgery, stroke, drugs, aging, etc. These factors may promote the occurrence of ED. 1、 The current situation of ED and the number of people suffering from ED are increasing and spreading to young people. A questionnaire survey of 2226 men over 20 years old in Beijing, Chongqing and Guangzhou showed that the incidence of ED among men under 30 years old in China was 15.6%, and that among men over 40 years old in China was 40.2%. In 2018, Changshan Pharmaceutical's announcement mentioned that at present, the number of ED patients in China is about 140 million. If according to the company's statement, there is one erectile dysfunction for every five Chinese men! In addition, the visit rate of ED is very low, only 15%~20%. Among the patients with erectile dysfunction, 40% are caused by diabetes, 30% by vascular diseases, 3% by prostate surgery, and other reasons include drug side effects, trauma, endocrine dysfunction, fibrosis of penile blood vessels and cavernous smooth muscle, and penile tumors. Dyslipidemia, hypogonadism, pelvic nerve injury and other factors may lead to ED. Most modern men do not mention the situation, not a simple physical condition, but a disease: erectile dysfunction (ED) is at work. More and more evidence shows that ED often occurs 2-5 years earlier than cardiovascular disease. After the emergence of ED, there will be a cardiovascular event in 2-5 years on average. This is because the diameter of the vessels in the cavernous body of the penis is smaller, while the vessels in the coronary artery are thicker. The same plaque, when it appears in the coronary artery, is not easy to be found. However, if it appears in the penis's blood vessels, it will produce cardiovascular risks that are easier to be found. If ED is not diagnosed and treated in time, there will be potential hazards of cardiovascular and cerebrovascular diseases. In an ED survey, 68% of hypertensive men have ED, 60% of ED men have dyslipidemia, and 40% of ED men have obvious coronary artery occlusion. Experts pointed out that ED patients regardless of age should be encouraged to actively diagnose and treat. 2、 New methods still need to be explored in the field of andrology. According to the Chinese Guidelines for the Diagnosis and Treatment of ED, the first representative drug for the treatment of ED is phosphodiesterase 5 inhibitor, such as sildenafil. Although some ED men will choose Viagra (the main ingredient: Sildenafil) to solve the "emergency" needs, temporarily restore the normal congestive erection of the penis, and then have a smooth sexual life. However, the effect of Viagra is one-time, and the duration is very short. After 4-8 hours of onset, the efficacy will gradually dissipate, allowing the patient to be returned to the original form quickly. For some people who need to take Viagra for a long time, this is obviously not friendly, and drug resistance may occur, and the problem has not been solved from the "root". Second and third line treatment includes vacuum erectile device, intraurethral suppository, intracavernous injection and penis implantation. However, these strategies have limitations, such as being unable to correct the pathological state of the penis, and limiting their application due to undesirable side effects, costs and effects, which highlights the urgency of comprehensively exploring the pathological mechanism and treatment strategies of ED. In recent years, with the in-depth study of regenerative medicine theory, it was unexpectedly found that stem cell therapy can improve sexual function when interfering with other diseases (diabetes, chronic kidney disease, spinal cord injury, etc.), which attracted the attention of researchers, and derived a new idea of stem cell therapy to improve male erectile dysfunction (ED). Stem cells used in ED treatment are expected to become an ideal way to treat both symptoms and symptoms of ED. 3、 The mechanism of stem cell therapy for male dysfunction The mechanism of stem cell therapy for male dysfunction mainly includes the following aspects: 1. Repair damaged tissues and nerves: an important reason for male dysfunction is the damage of tissues and nerves. Stem cells can differentiate into different types of cells, and can promote tissue repair and regeneration. Transplanting stem cells can help repair damaged tissues and nerves, thus improving male dysfunction. 2. Promote angiogenesis: male erections need adequate blood supply. Stem cells can promote angiogenesis and enhance the function of blood vessels. Therefore, transplantation of stem cells can promote angiogenesis and increase blood flow, thereby improving erectile function. 3. Promote nerve regeneration: nerves are an important part of male sexual function. Stem cells can promote nerve regeneration and repair. Transplantation of stem cells can promote nerve regeneration and repair, thus improving male dysfunction. 4. After cell differentiation stem cells are transplanted, they differentiate into endothelial cells, smooth muscle cells and nerve cells under the stimulation of the pathological microenvironment of the corpus cavernosum of the penis, so as to repair damaged tissues and promote the improvement of erectile function. 5. Paracrine stem cells can secrete a variety of growth factors and act on damaged tissues through paracrine to promote tissue repair. Studies have shown that stem cells can secrete vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), insulin-like growth factor-1 (IGF-1), brain derived neurotrophic factor (BDNF), matrix derived factor-1 (SDF-1), interleukin-6 (IL-6), fibroblast growth factor (FGF) and angiopoietin-1. These growth factors play an important role in improving erectile dysfunction. 6. The vector stem cells of gene therapy can not only promote the repair of damaged tissues through a variety of mechanisms, but also serve as the vector of gene therapy. Therapeutic genes are introduced into stem cells through various methods. With the survival and expansion of stem cells in the transplant site, therapeutic gene products are highly expressed to achieve therapeutic purposes. Endothelial nitric oxide synthase (eNOS) is an important molecule in the erectile signaling pathway and can be introduced into stem cells. Over expression of eNOS in penis tissue can improve erectile function. After transplantation, it can promote the growth of endothelial cells, improve the tissue structure of cavernous body, and improve erectile function. 7. Bridging function Bridging function refers to that stem cells provide a bridge for the regeneration of injured axons and help regenerated axons pass through the injured site smoothly. After transplantation, stem cells can not only differentiate into neural tissue cells, secrete a variety of growth factors, promote the growth of neural tissue, promote the repair of damaged neural tissue in the cavernous body, but also promote the repair of neural tissue in the cavernous body through bridging. 8. Stem cells can also reduce inflammatory reaction and improve tissue microenvironment through immune regulation. 4、 The role and mechanism of stem cells in the treatment of various EDs 1. Diabetic ED: erectile function requires the combined action of nerve, endothelium and smooth muscle tissue. However, diabetes destroys the hemodynamics of penile blood vessels through chronic hyperglycemia, hypoxia and reduction of NO production. The mechanism of stem cells in treating diabetic ED includes: on the one hand, stem cells differentiate into endothelial cells, smooth muscle cells, nerve fibers and other different types of cells in the cavernous body; On the other hand, stem cells can secrete many factors, such as VEGF, brain-derived neurotrophic factor (BDNF), which can increase the expression of nNOS and eNOS, activate NO/cGMP pathway, and improve erectile function. In an open phase I clinical trial, autologous bone marrow mesenchymal stem cells (BMSC) were injected into the penis of diabetic ED patients for the first time for two consecutive times. The results showed that the surgery was well tolerated, without obvious adverse reactions, and the patients' International Erectile Function Index (IIEF-15) and Erectile Hardness Score (EHS) were improved. Stem cells not only improve ED, but also effectively reduce blood glucose. Bahk et al. have done this pioneering research. The reason for innovation is that the stem cells used are provided by a company, not from patients. Seven diabetes related ED patients aged 57~83 years were injected with umbilical cord stem cells (1.5 × 10 ^ 7). The results showed that most of their participants recovered their morning erections within one month and lasted for more than six months. In addition, their blood sugar levels declined after two weeks, highlighting the positive results of human umbilical cord blood stem cell therapy in both ED and diabetes. 2. Cavernous nerve injury ED: Neurogenic ED (NED) is one of the complications of radical prostatectomy (RP), which can occur in more than 50% of patients. Although nerve sparing RP can reduce the incidence of ED, many men will still have ED within 2 years after the operation. The ideal method for treating NED is to restore the damaged cavernous nerve (CN) to prevent the apoptosis of corpora cavernosa (CC) cells and improve the function of vasodilator factors. Stem cell therapy may reverse the structure and neural factors of NED. In terms of clinical trials, Yiou et al. included 12 ED patients after RP surgery. After BMSC injection, most people's sexual function scores were significantly improved, and 9 of the 12 patients had successful sexual intercourse after drug treatment. In 2016, Haahr et al reported that 17 men received a single ICI treatment after RP surgery 5 to 18 months before joining the group. After the injection of adipose derived stem cells (ADSC), 8 of 17 patients recovered erectile function and had the ability to complete sexual intercourse. Two years later, Haahr et al reported that 8 of the 15 patients treated with RP completed sexual intercourse at 12 months. 3. Aging ED: aging will cause increased penile vascular tension, inactivation of eNOS, decreased nNOS, and decreased penile erectile response to CN stimulation. In addition, aging is also related to the increase of collagen fibers, the decrease of smooth muscle cells and the degeneration of elastic fibers in the penis. Therefore, the ideal way to treat senile ED is to reverse or prevent these changes. 4. Penile induration ED: PD is a connective tissue disease, which is characterized by fibrous plaque in the penile tunica albuginea, leading to penile deformity, bending and ED. The pathogenesis of PD induced ED is not clear. At present, the most widely accepted theory is inflammation, elastic fiber breakage and fibrin deposition caused by penis microvascular injury. Now more and more evidence shows that stem cells have anti fibrosis effect. Stem cells play a role through immune regulation, thus limiting the host's response to injury and preventing the occurrence of fibrosis. 5. Hyperlipidemic ED: ADSCs were transplanted into the corpus cavernosum of the rat penis. The results showed that the erectile function of the stem cell group was significantly better than that of the control group. More endothelial cells and nerve fibers with positive neuronal nitric oxide synthase were found in the penis tissue of the stem cell group. 6. Spinal cord injury ED: Researcher Nout injected glial progenitor cells into spinal cord injured rats, and found that the number of erections occurred in the rats within 24 hours, and the autonomic nervous function was repaired to a certain extent. 5、 There are two clinical methods of stem cell therapy for ED: 1. Intravenous reinfusion: the stem cells are transfused back into the body like blood transfusion, and then the stem cells migrate to the target site through blood circulation for tissue repair. The advantage of intravenous reinfusion is simple operation, but the disadvantage is that the number of cells entering the target site is limited; 2. Targeted therapy: The advantage of targeted therapy is that most cells can enter the target site to play their functions, but the disadvantage is that it requires professional and accurate operation. 6、 Stem Cell Therapy Advantage Stem cells are called "universal cells", which can repair human organs and tissues and resist aging. At the same time, stem cells also play an important role in the repair of the reproductive system. Through the infusion of stem cells, men with erectile dysfunction can restore masculinity and improve the quality of sexual life. Compared with traditional drugs for erectile dysfunction, stem cell therapy has the following advantages. 1. First of all, stem cell transplantation is a non-invasive treatment method, which can avoid the trauma and risk caused by surgery. 2. Intelligence of repairing damaged tissue stem cells: where the damage is repaired! After the stem cells enter the patient's body, their own "homing" characteristics can enable them to accurately reach all directions that affect the male reproductive mechanism and need to be repaired for comprehensive repair. After stem cells are transplanted into the human body, most of the stem cells will automatically migrate to the diseased parts, comprehensively repair the damaged body, treat both the symptoms and the symptoms, and restore the normal sexual function of men. Moreover, drugs cannot repair tissues and organs. Drugs can only stimulate male sexual function and improve sexual life in a short time. 3. Long lasting and effective stem cells can be transplanted into the human body to repair male damaged organs and tissues, and fundamentally restore male erectile function, with a lasting effect. In the previous clinical trial of stem cell therapy for erectile dysfunction, no signs of male erectile dysfunction were found during the one-year follow-up period. The drug treatment can only play a role in a short time, once the efficacy subsides, it will be returned to its original form. 4. Safe and no side effects The stem cells do not have immunogenicity, and will not produce rejection after transplantation into the human body, so they are safe and no side effects. As for drugs, there are three kinds of drugs, so stimulating the body to make corresponding reactions through drugs will inevitably cause side effects. It is pointed out that long-term use of aphrodisiac will produce various side effects, including permanent impotence, temporary deafness, headache, dizziness, glaucoma, infertility, etc. 5. Stem cell transplantation can cure erectile dysfunction caused by a variety of reasons: unlike drugs that only target specific molecules or signal pathways, stem cell transplantation simplifies the regulation process in the form of direct differentiation to replace damaged cells or paracrine a large number of cytokines. It can be applied to different types of dysfunction. 7、 Real clinical cases of stem cell therapy for ED Since Ernst Haeckel put forward the concept of stem cell in 1868, the exploration of stem cells and their application in diseases have always been the focus of scientific research and clinical practice. In fact, they are of great significance in treating various diseases and have greatly promoted the development of regenerative medicine. The application of stem cells in ED started late, and it was not reported until the 21st century. However, stem cell therapy (SCT) has achieved a surprising phased goal in ED. Many basic and clinical trials have confirmed that SCT can partially restore erectile dysfunction caused by various factors and improve the quality of sexual life. More importantly, stem cells can not only alleviate symptoms, but also alleviate ED by solving the pathological mechanism, including differentiating into specific effector cells, secreting a large number of growth factors and exosomes, thereby improving the local pathological environment and stimulating tissue repair. Clinical study 1: Stem cells not only improve ED, but also effectively reduce blood glucose. In 2010, 5 people including Jong YoonBahk from Gyeongsang National University Medical Graduate School in South Korea carried out a pioneering study on erectile dysfunction caused by diabetes in 7 patients aged 57-83 (mean 69.5 years) UCSCs (1.5 × 107) of umbilical cord blood stem cells were injected into the sponge of patients. The results showed that most people recovered their morning glory within one month and lasted for more than six months. After 6 months, 2 people achieved satisfactory sexual life. After 9 months of follow-up, 6 people showed increased sexual desire. In addition, their blood sugar level dropped after two weeks, and cord blood stem cells showed positive results in the treatment of ED and diabetes. The subjects were divided into groups and given increasing doses of stem cells (2 × 107, 2 × 108, 1 × 109 and 2 × 109). The results showed that after 6 months of treatment, the patients receiving the highest dose observed the most significant improvement without serious side effects, which was related to the improvement of peak systolic velocity measured by penis triad. In addition, the team published the second phase of research in 2017, pointing out that the optimal dose is 1 × 109 doses. Clinical study 2: Stem cells are effective against ED patients who are not effective in "Viagra". In 2015, Dr Zahalsky and other researchers have carried out one of the earliest studies on the feasibility of using stem cells to treat ED with literature available. In this study, eight patients were injected with human placental mesenchymal stem cells (PMMSCs). During the 6-week follow-up, PSV ranged from 25.5cm/s to 56.5cm/s; At 3 months, the PSV range is 32.5cm/s to 66.7cm/s. The increase of PSV was statistically significant (P. At 6 months, the variation range of PSV was 50.7cm/s to 73.9cm/s (P<0.01). During the 6-week follow-up, 2 patients who had failed in oral treatment were able to maintain their erections. During the 3-month follow-up, another patient was able to achieve self erection. The clinical trials number is NCT02398370. The researchers and participating doctors believed that in the case that oral medicine could not significantly improve ED, injection of stem cells could have a more significant effect. Clinical study 3: another important study in 2016, in which higher doses of stem cells have significant effects on ED, evaluated the use of different amounts of stem cells per injection for the first time. YOU et al. reported the effect of BMSC injection on vascular ED patients undergoing radical prostatectomy in Phase I/Pilot study. Specifically, they divided the participants into four groups and gave them increasing doses of stem cells (2 × 10 ^ 7, 2 × 10 ^ 8, 1 × 10 ^ 9 and 2 × 10 ^ 9 stem cells). Their results showed that the patients who received the highest dose of stem cell therapy 6 months after treatment observed significant improvement without serious side effects, which was related to the improvement of peak systolic speed measured by penis triad. The same team published a phase II study in 2017, pointing out that the optimal dose is 1 × 10 ^ 9. Clinical study 4: The therapeutic effect of stem cells can last for 12 months. Haahr et al. showed that injecting 8.4 million to 37.2 million fresh isolated autologous adipose derived stem cells ADRC into the sponge is a safe and effective method for ED patients undergoing radical prostatectomy (RP). In addition, no serious adverse reactions were observed during the 12 month follow-up. Most participants recovered erectile function within 6 months, and this effect lasted for 12 months. Clinical study 5: In 2016, American researcher Jason A Levy et al. published the results of a clinical study on placental mesenchymal stem cells (PM-MSC) in the Journal of the American Osteopathic Association. A total of 8 patients were included in this study. They were followed up 6 weeks, 3 months and 6 months after PM-MSC was injected into the corpus cavernosum of the penis. 1) At 6 weeks, 3 months and 6 months after injection, the peak systolic velocity (PSV) of penile artery increased significantly; 2) The changes of EDV, stretched penis length, penis width and IIEF-5 were not statistically significant; 3) Six weeks after the injection, two patients who had failed in previous oral treatment were able to maintain their erections on their own, and three months after the injection, another patient was able to self erect. Clinical study 6: Mahboubeh Mirzaei et al. carried out a randomized, single blind study on the treatment of diabetic ED with oral mucosa MSC in Iran, and the results were published in the journal Urology Journal. A total of 20 diabetic ED patients were included in the study, 10 patients were injected with MSC through the penis cavernous body (intervention group), and 10 patients were injected with normal saline (control group). The patients were followed up 3 months and 6 months after injection. 1) The average IIEF5 score in the intervention group showed a significant upward trend (P=0.01), and the average IIEF5 score before injection, 3 months after injection, and 6 months after injection were 7.2 ± 2.1, 9.2 ± 3.4, and 10.6 ± 4.7, respectively; 2) Compared with the control group, the IIEF5 score of the intervention group changed significantly within 6 months after injection (P=0.02); 3) In terms of peak systolic velocity (PSV) and resistance index (RI) of the penile artery, there was no statistically significant difference between the two groups, but these indicators in the intervention group showed an upward and improving trend; 4) At 3 months, one patient in the intervention group and another patient in the same group at 6 months after injection reported morning erections, but during the 6-month follow-up period, no patient in the control group reported morning erections. Clinical study 7: In 2018, the team from Jordan University School of Medicine, Amman, Jordan, Jordan reported the clinical results of four diabetic patients with refractory erectile dysfunction who underwent two consecutive autologous bone marrow MSCs in the cavernous cavity. The patients' International Erectile Function Index - 15 (IIEF-15) and Erectile Hardness Score (EHS), libido, sexual intercourse satisfaction, and overall satisfaction have all improved significantly. Clinical study 4: Haahr et al. [4] carried out a clinical trial of stem cell therapy, and selected 17 patients with ED after RP who failed to respond to drug therapy. After injecting autologous ADSCs into the penis sponge of all patients, they were followed up for 6 months, during which IIEF and EHS were used to evaluate the erectile function before RP and 1, 3, and 6 months after ADSCs treatment. After the injection of ADSCs, 2 patients showed redness and swelling reaction at the injection site, but the duration was relatively short. One patient showed hematoma in the scrotum and penis and subsided within 14 days. In addition, there were no other obvious adverse reactions. After treatment, 8 patients recovered their erectile function and could complete satisfactory sexual intercourse. EHS also improved significantly at the 6th month. Clinical study 8: Haahr et al. conducted a clinical trial of stem cell therapy, and selected 17 patients with ED after RP surgery who failed to respond to drug therapy. After injecting autologous ADSCs into the penis sponge of all patients, they were followed up for 6 months. During this period, IIEF and EHS were used to evaluate the erectile function before RP surgery and 1, 3, and 6 months after ADSCs treatment. Results: After the injection of ADSCs, 2 patients had redness and swelling reaction at the injection site, but the duration was short. One patient had hematoma in the scrotum and penis and subsided within 14 days. In addition, there were no other obvious adverse reactions. Clinical study 9: In January 2019, Protogerou et al. carried out a prospective clinical study. The team divided 8 organic ED patients (with diabetes, hypertension, hypercholesterolemia and other basic diseases) into two groups on average, and injected fat mesenchymal stem cells+blood plate lysate into one group; The other group was injected with platelet lysate. To sum up, stem cell therapy has opened the "door of sexual well-being" for ED patients, showing its effectiveness and safety. In addition, stem cells can significantly repair the aging and degeneration of the reproductive system while repairing the aging of all organs in the body. It can significantly improve and improve the male sexual function. Stem cell therapy provides another option for patients with ED, and has great potential for clinical application. It is believed that in the near future, scientists will further investigate the safety and effectiveness of stem cells in the treatment of ED by carrying out large-scale randomized, double-blind, controlled studies, and answer questions such as which kind of stem cells is more effective, the dose and frequency of injection, so as to provide more reference information for the clinical application of stem cells and provide more treatment options for men suffering from ED. Let ED patients regain their confidence and regain their masculinity. Finally, I wish you to leave half your life and return as a teenager!

Blood activating and depression relieving drugs in traditional Chinese medicine: Yanhusuo, turmeric, salvia miltiorrhiza, musk, ginseng, tulip, Xu Changqing, rhodiola.

The implantation of penile prosthesis is usually performed under general anesthesia or lumbar anesthesia, so patients will not feel pain during the operation. After surgery, there may be some discomfort and pain, but the doctor will prescribe painkillers to help manage these symptoms. The sensory nerve of the penis is very rich, so there may be some discomfort after the implantation of the penis prosthesis, especially in the early stage after surgery. Pain is generally tolerable, and persistent pain is often concentrated in the distal penis and perineum. Because the proximal end of the prosthesis is located at the end of the penis foot, adjacent to the pudendal nerve, it can produce tractive perineal and scrotal pain, sometimes it can be considered as testicular pain, and the pain is generally within 4 weeks. If it is severe, it may be because the prosthesis is too long and should be re operated. The prosthesis can be taken out through a small incision in the coronal groove, and 0.5 cm can be repaired and then inserted, which can quickly relieve the pain. Will the switch at the scrotum be painful when the penis prosthesis is implanted? There was pain at first, and there was scrotal swelling. Then the pain completely subsided in a month. At first, I felt uncomfortable when I switched on and off, but it was not completely painful. The risks and complications of surgery may include infection, prosthesis failure, pain or discomfort at the surgical site, and the possibility of requiring a second operation. Before deciding whether to undergo surgery, you should discuss these potential risks and complications with your doctor, as well as possible other treatment options.  

The erection controlled by penile prosthesis is similar to natural erection, and the erection hardness is often higher than natural erection; However, after penis prosthesis surgery, men will no longer be able to erect naturally. This is because during the operation, doctors need to create space in the spongy body of the penis to place the prosthesis. This process will change the structure of the penis, making natural erection impossible. However, the prosthesis can simulate the process of erection. Specifically, the semi rigid penile prosthesis can maintain a certain hardness of the penis and can be bent to different positions. Inflatable penis prosthesis can be inflated and deflated by manual pumping, thus simulating the process of erection and atrophy. The prosthesis will not change the feeling on the penis skin or the man's ability to reach orgasm, nor will it affect ejaculation. If there is ejaculation function before operation, it can also ejaculate after operation. Although penile prosthesis can not restore natural erection, many men find that they can effectively help them with sexual activities. However, this operation is irreversible, so before deciding to perform the operation, you should fully understand its risks and benefits, and have a detailed discussion with the doctor.      

Penile prosthesis is the ultimate weapon for the treatment of severe erectile dysfunction (impotence). However, there are too few articles about it in China, and because of the high price, most of the patients do not have the opportunity to access more information, so many people, like ponies crossing the river, do not know the depth of the water. The sensory nerve of the penis is very rich, so there may be some discomfort after the implantation of the penis prosthesis, especially in the early stage after surgery. Pain is generally tolerable, and persistent pain is often concentrated in the distal penis and perineum. Because the proximal end of the prosthesis is located at the end of the penis foot, adjacent to the pudendal nerve, it can produce tractive perineal and scrotal pain, sometimes it can be considered as testicular pain, and the pain is generally within 4 weeks. If it is severe, it may be because the prosthesis is too long and should be re operated. The prosthesis can be taken out through a small incision in the coronal groove, and 0.5 cm can be repaired and then inserted, which can quickly relieve the pain. Therefore, in the recovery period after the penis prosthesis operation, there may be some pain, which is normal. However, once you have fully recovered, the use of a penile prosthesis usually does not cause pain. Will the switch at the scrotum be painful when the penis prosthesis is implanted? There was pain at first, and there was scrotal swelling. Then the pain completely subsided in a month. At first, I felt uncomfortable when I switched on and off, but it was not completely painful. The penis prosthesis is water filled and erect, and the penis has no uncomfortable feeling, and has a sense of fullness and expansion. The firmness can be controlled by yourself according to the amount of skin bag you pinch. The firmness can also be adjusted by yourself. The duration will last until you turn the switch. The penile prosthesis is designed to be as comfortable as possible when used. Expandable penis prosthesis, such as the "three piece set" prosthesis, allows men to control the erection and softening of the penis by squeezing the pump in the scrotum, which usually does not cause pain. Similarly, semi rigid penile prosthesis can also be manually adjusted to erectile or non erectile status, usually without causing pain. However, if you feel persistent pain or any other discomfort when using a penis prosthesis, you should contact your doctor immediately. This may be a sign of infection, mechanical failure of the prosthesis or other problems, which need timely medical evaluation and treatment. In general, penis prosthesis surgery is an important medical decision and should be carried out after careful consultation and consideration. You should discuss with your doctor all possible risks and complications, as well as other possible treatment options, in order to make the decision that best suits you.