As the first and only men's sexual health centre in Istanbul, we offer special treatment methods with a holistic approach to our patients with erectile dysfunction.
What Is Erectile Dysfunction? Erectile Problems
Our approach to patients with erectile dysfunction. What are our treatment protocols? A personalised approach.
Whatever the level of a patient's sexual problem, a treatment method suited to them is planned for anyone who comes to the AndroFert Men's Health Clinic. In erectile problem treatment in Istanbul, instead of the same treatment for everyone, a PERSONALISED treatment concept is applied. So what is this PERSONALISED TREATMENT concept?
First of all, every man has a different view of sexuality. Some patients want to have intercourse every day, while others prefer once a week or once every two weeks. The underlying reason is usually the man's TESTOSTERONE level. Sometimes a male patient has more than one partner and needs treatment accordingly; other patients have a single partner and prefer to have intercourse less often.
In our clinic the patient's expectations are determined first. Then a detailed examination of the penis and testicles is performed, the blood supply of the penis is examined with Doppler ultrasound and, if there is any suspicion, prostatitis is reviewed.
After this stage the patient's HbA1c test showing the 3-month blood sugar average, cholesterol, kidney and thyroid tests, vitamin balance and, most importantly, the level of the male hormone testosterone are measured.
As a result of this evaluation, the patient's deficient hormones and vitamins are supplemented, and shockwave therapy with the state-of-the-art Piezo device and penile PRP sessions are planned.
Patients who are inactive and do not exercise are strongly advised to exercise, walk, lose weight if they have a weight problem and get enough sleep. If the patient has uncontrolled high blood sugar and cholesterol, an appointment with an endocrinologist is arranged. Men under high stress are also helped with psychological support if they wish.
Throughout the planned treatment, contact with the patient is never lost and their condition is constantly checked; when necessary the patient is re-evaluated. The aim is for the patient to regain a healthy sex life. If the patient's erectile condition is severe, training is given for penile injection therapy, or detailed information is provided and surgery planned for a penile prosthesis.
What matters at Dr. Muhsin BALABAN's clinic is solving the sexual problems of the patient who comes to us and having the patient leave the clinic happy. That is why whatever is necessary on this subject is planned and applied.
Why does erectile dysfunction occur?
Erectile failure, known as erectile dysfunction, can stem from physical (organic) or emotional (psychological) causes.
When we say physical cause, vascular disease comes to mind first. In uncontrolled diabetes and in the presence of high cholesterol the vessels of the penis harden and not enough blood reaches the penis; as a result erectile problems begin in the man. Another cause may be related to hormones. For example, a high level of the hormone prolactin secreted by the brain can cause erectile problems. Likewise, insufficient testosterone secreted by the testicles can cause reduced performance and erectile dysfunction in men.
With a psychological cause, erectile failure occurs because of a psychological problem of the patient. Most patients fall into this group. Feelings of inadequacy, expectations of high performance or general anxieties about life can unfortunately cause erectile problems. This is identified after a detailed patient history and physical examination, and a treatment plan is made accordingly.
Is there a permanent treatment for erectile dysfunction?
The answer to this question is YES. The aim of all the treatments we apply in our clinic is to offer a permanent solution to erectile failure. But after the treatments given for this purpose, the patient must pay attention to their general health and psychological state. To maintain the improvement achieved, the patient must pay attention to nutrition, weight and exercise. In heavy smokers and those who gain weight erratically, even if the erectile problem improves there is a risk of experiencing the problem again after a while. That is why all patients treated in our clinic are given recommendations and some exercises for healthy living. If hormone levels are kept balanced at annual check-ups and general health is protected, the treatment the patient receives will be permanent.
Can combined treatments be applied?
For erectile problems, PDE5 inhibitors, shockwave therapy, penile PRP therapy and stem cells are applied. These treatments can be used in combination. For example, to increase the effectiveness of penile PRP therapy, shockwave therapy should be performed at the same time: while shockwave therapy strengthens the existing penile vessels, PRP will start the formation of healthier new vessels. Performing shockwave therapy beforehand in patients who will receive stem cell therapy will contribute to the greater success of the stem cell treatment.
Which tests may be requested before starting erectile dysfunction treatment?
In patients presenting with erectile failure, a detailed blood test may first be requested to examine the hormonal status. In particular, total testosterone, LH, prolactin, HbA1c showing the 3-month blood sugar average, thyroid tests, vitamin D and vitamin B12 will give us information about the patient's blood picture. In patients with a serious erectile problem, a scan called penile Doppler can be performed to evaluate the condition of the penile blood vessels. In this scan a special substance called papaverine is injected into the penile tissue to produce an erection, and the intensity of blood flow in the penis is measured by ultrasound at 10, 15 and 30 minutes. This test can give 3 results: arterial insufficiency, venous insufficiency or a normal examination. If the result is interpreted as normal, it is concluded that the patient's erectile failure has a psychological cause.
Which treatments are available when PDE5 inhibitors are ineffective?
If oral medications are ineffective, the patient can be offered, in order, shockwave therapy called ESWT, penile PRP, stem cell therapy, penile injection therapy or the penile prosthesis, known as the “happiness stick”.
Testosterone therapy in the treatment of erectile dysfunction
The hormone testosterone plays a critical role in erection. In men, testosterone levels can sometimes be low at advanced ages or with excess weight and an inactive lifestyle. Low testosterone in men also causes the clinical picture called andropause. The most prominent features of low testosterone are low energy, fatigue, low mood, reduced mental function and erectile problems.
In testosterone replacement therapy, the deficient hormone is supplemented with an intramuscular injection once every 21 days or once every 3 months. Some forms of testosterone are gels and are applied every 3 days to a hairless area of the body. The point to note is that if the man plans to have children, testosterone hormone therapy is not recommended.
To raise testosterone naturally, muscle-building sports, a regular exercise programme and a Mediterranean-style diet are recommended for men.
What is self-injection therapy?
Self-injection therapy is recommended for patients who have not benefited from PDE5 inhibitors, shockwave therapy and penile PRP and who are not in favour of stem cell therapy or a penile prosthesis. The patient is given a ready-made drug. With an insulin syringe, when needed, the patient delivers the prescribed dose into the penis from the side, in an area without vessels. Before this the patient goes through application training and becomes able to perform the injection comfortably. Five minutes after injecting into the penis, an erection begins and lasts on average 30 minutes to 1 hour; then, as the effect of the drug wears off, the rigidity ends. This treatment can be used only when needed. The most important point is that the patient pays attention to hygiene and uses the appropriate dose. It can be recommended for patients who do not have intercourse very often and do not want stem cell or penile prosthesis treatment.
Intracavernosal (ICI) and intraurethral (IU) treatments for ED
An erection can also be produced with a special drug delivered into the urethra, i.e. the urinary canal. This drug also has a cream form: applied to the area where the urinary canal opens on the penis, the cream can produce an erection. Alternatively a specially formulated drug can be delivered into the urinary canal. Redness and irritation of the penile skin, dizziness and low blood pressure are the most common side effects.
Surgical treatment of erectile dysfunction
If the patient does not benefit from any of the treatment options applied, surgical procedures come into the picture. Penile prosthesis surgery, popularly known as the “happiness stick”, is widely performed. Penile prostheses come in 2 types: malleable and inflatable.
The penile prosthesis is the most guaranteed treatment method for erectile failure, with 100% effectiveness. This device, placed inside the penis, is not noticeable from the outside and, most importantly, there is no reduction in sensation during sexual intercourse.
Can a man with a penile prosthesis have children?
The answer to this question is a clear yes, because the penile prosthesis does not affect the pleasure experienced or the semen released at orgasm. It is widely used especially in Western countries and in the Arab world.
How many types of penile prosthesis are there?
Two-piece malleable prosthesis
These prostheses consist of two pieces and are placed inside the tubes of the penis called the cavernosa. Their advantage is that the surgery is short and the return to work is quicker. When the patient wants intercourse he straightens the prosthesis and has intercourse comfortably; after ejaculation he can bend the prosthesis himself. Prostheses from different manufacturers are available. These state-of-the-art prostheses are antibiotic-coated and the risk of infection is very low.
Three-piece inflatable prostheses
The operation takes a little longer. There is a pump system next to the testicles, a reservoir inside the abdomen and the prosthesis itself inside the penis. It is not noticeable from the outside. When intercourse is desired, the pump next to the testicles is pressed to activate the prosthesis; when intercourse is over the same mechanism is pressed to deflate the penis. These prostheses usually carry a lifetime guarantee.
They are easy and comfortable to use. Patient and partner satisfaction is over 95%.
There is no change in the sensation of sexual pleasure in patients fitted with a prosthesis. Ejaculation occurs, and the patient can have children if he wishes. It is very widely used in the Arab world and in Western countries.
Prostheses that expand in both girth and length
Thanks to advances in technology, prostheses that expand both in girth and in length have been developed. Although more expensive, many patients choose this special new prosthesis. The girth and length of the penis increase somewhat.
Our ED treatment methods in patients after cancer surgery
After prostate cancer surgery or pelvic surgery the nerve and vascular network of the penis is damaged. Some of these patients can benefit from PDE5 inhibitor therapy, shockwave therapy or stem cell therapy. For patients who do not benefit despite these treatments, the option of a penile prosthesis comes up.
A penile prosthesis is a special mechanism made of a special material and placed inside the tubes of the penis called the cavernosa. There are 2 types: two-piece and three-piece inflatable.
Our approach to patients after erectile dysfunction treatment at our clinic
Follow-up of our patients who come to our clinic and are treated for erectile dysfunction continues. Once every 6 months patients are invited to our clinic and their general condition and erectile strength are checked. A blood test is requested and the testosterone level is examined. In this way the sexual health of our clients treated at our clinic is protected for many years.
ESWT shockwave therapy in the treatment of erectile dysfunction
ESWT / shockwave therapy is a treatment for erectile failure that has become popular in recent years and has no side effects. It works on the principle of regenerating the underperforming or non-functioning tissues in the penis thanks to therapeutic waves generated by a special device. Applied in sessions, this treatment has no side effects and shows over 85% effectiveness. It is suitable for men with mild to moderate erectile failure.
Stem cell therapy in the treatment of erectile dysfunction
Stem cell therapy in erectile dysfunction is becoming more popular and more widely applied day by day. The main principle of this treatment is to obtain the stem cell, which we call the parent cell, from the body and then place it in the damaged organ. For erectile failure we obtain the stem cells from abdominal fat by a special process and place them inside the corpora cavernosa of the penis. Within 3 months these stem cells form new blood vessels and tissue inside the penis. It shows 70% effectiveness in patients with severe erectile dysfunction.
P-SHOT in the treatment of erectile dysfunction
P-SHOT, or penile PRP therapy, acts on the principle of regenerating the penile tissues and forming new blood vessels. In PRP therapy, blood taken from the patient is put through a special process to obtain a fluid rich in platelets and growth factors. This PRP is then injected into the tissues of the penis. As a result the patient has more sensation and better erections. Some patients report that after this procedure the penis has become thicker and slightly longer. The aim of penile PRP therapy is to increase erection quality. It has no side effects and is a repeatable procedure.
