The following are the recognized treatment options for erectile dysfunction:
- Trimix Therapy
- Shockwave Therapy
- Oral Medication
- MUSE - Medicated Urethral System for Erections
- Vacuum Device
- Penile Implant
- Lifestyle Changes
- Counseling (Sex Therapy)
Trimix Therapy ("3P" medications therapy) was first introduced in early 1980s and has been widely used by doctors around the USA, Europe, Latin America, Australia for decades. In Hong Kong, the therapy has been practiced by doctors since 2004. The efficacy and tolerability of Trimix Therapy is clinically proven by hospitals and universities worldwide. Due to the usage of a mixture of 3 registered and recognized vasoactive agents starting with the letter "P", namely, Prostaglandin E1 (PGE1)*, Papaverine**, and Phentolamine***, Trimix Therapy is also named "3P" Medications Therapy in the market.
Client's Feedback About Trimix Treatment
PGE1 is an FDA-approved vasodilator, and was first used in 1975 in infants with a congenital heart disease called "obstructive right heart malformation". When used in Trimix Therapy, it causes relaxation of smooth muscle in the corpus cavernosa (spongy body) and penile arteries. Dilation of these structures temporarily increases blood flow into the cavernosa sinusoids while also occluding the penile venules responsible for drainage. These effects lead to increased penile blood pressure and rigidity, and hence a maintained erection.
Studies show that PGE1 can prevent long-term post prostate operation damage by periodically increasing oxygenation of the corpus cavernosa (spongy body).
** PapaverinePapaverine has been used for over 20 years: for the treatment of Alzheimer's disease and multiple sclerosis, and to dilate heart arteries, Papaverine inhibits the phosphodiesterase enzyme responsible for the degradation of cyclic adenosine monophosphate (cAMP). The inhibition of phosphodiesterase and subsequent elevation of cyclic adenosine monophosphate leads to smooth muscle relaxation.
*** PhentolamineThe relaxant effects of phentolamine are through blockade of both alpha-1 and alpha-2 adrenergic receptors, inhibiting nerve signals for arterial wall contraction.
The effects of phentolamine lead to dilation of penile arteries, resulting in increased blood flow into the cavernosa sinusoids. As these tissues are filled with blood, the penis erects.
Trimix Therapy helps revitalize the erectile organ by stimulating and activating the lethargic vasculature of the penis. Patients receiving this therapy need to self-inject medicines into the penis to help the blood vessels to dilate. Erection occurs about 5-15 minutes after injection, with 80-100% hardness. The success rate for an adequate erection is about 95%.
The injection is painless - the skin will only feel like a tickle because:
- There are few nerve endings for pain sensation in the injection site. An Ultrathin needle (29 Gauge, which translates to diameter of 0.33mm) is used in the injection. From our clinical experience, 29 Gauge is the finest recommended needle for the injection.
- Injection can be assisted by an auto-injector, which can insert the needle into the tissue very quickly, minimizing the discomfort and psychological hesitancy.
Unlike over-the-counter drugs, "3P" medications must be prescribed by a registered doctor. To determine the most suitable dosage, the doctor will conduct relevant tests to evaluate patients' blood flows and the nervous system.
After completing the full course of treatment and following doctors' advices, most of the patients will see significant improvement in the ability of erection and will achieve spontaneous erection eventually without the need of medication.
Based on many clinical studies, Trimix Therapy is an excellent treatment option with proven efficacy and tolerability, and can provide long-term curative effect. With good compliance to the therapy, some men regain normal and spontaneous erections, according to clinical studies.
Highlights of Trimix Therapy
- First FDA-approved (PGE1) medication for the treatment of erectile dysfunction.
- Long history since 1982, before the invention of oral medication.
- Over 80% of men in clinical trials achieved firm erections for sexual intercourse regardless of their age or the cause of their problem.
- Works for more than 95% of men who fails to respond to oral medication.
- Erection can be maintained for 30-60 minutes.
- Works for men with a broad range of medical conditions.
- Individualized dosage according to patient's' needs.
- Produces a safe predictable erection.
- As the medication is being injected directly into the spongy tissue, it is the only medication that could by-pass the nerve system for sexually desire and provide an erection independent of sexual stimulation. For patients who have received operation due to prostate disease or spinal injury, they can regain their erection after using the trimix treatment.
- Since the medication last for 30-60 minutes, an erection can be maintained even after ejaculation (it also works for PE patients).
- Some ED patients who have no other complicated chronic illnesses regained spontaneous erections after using a period of injection therapy.
Like all medical treatments, Trimix Therapy has some possible side effects, such as prolonged erection, infection, bruising and fibrosis at the injection site. However, following doctor's instructions on injections helps minimize such risks.
Other remarks of Trimix Therapy
- Prolonged erection may occur in certain patients. Therefore, professional monitoring is strongly recommended.
- The cost of "3P" medications is generally higher than other medications.
- Since good treatment compliance is necessary for satisfactory therapeutic effects, "3P" medications need to be applied every few days throughout the treatment course.
Goal of Trimix Treatment
The ultimate goal of Trimix treatment is the satisfaction provided to both the patient and his sexual partner. We aim to achieve a long-term impact that focuses on a curative approach rather than treating symptoms with life-long dependence on medications.
Effective treatment can allow patient to restore erectile function. Following the treatment program, most patients are able to have satisfactory erection, without the need for further treatment.
Related Video
Some medical literature regarding Trimix Therapy 1
Some medical literature regarding Trimix Therapy 2
Some medical literature regarding Trimix Therapy 3
What is Extracorporeal Shockwave Therapy?
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Extracorporeal Shockwave Therapy (ESWT) is the technology using pulses of sound energy called "shockwaves" to apply onto the treatment area.
ESWT is commonly used in different medical areas such as Urology, Cardiology, Orthopedics, Physiotherapy and Thermotherapy. In 2005, shock-waves were successfully used to treat reversible ischemic tissues in the heart, which helped inducing neo-vascularization and developing new collaterals. (1) |
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How does ESWT help sexual dysfunction?
Shockwave treatment can be used for treatment of vascular-based erectile dysfunction problems. We called this as Erectile Dysfunction Shockwave Therapy (EDSWT). EDSWT utilizes low-intensity extracorporeal shock waves, focusing on blood vessels and encouraging neo-vascularization in the penis shaft and corpus. The low-intensity shock waves help relieve vascular deficiency. This action stimulates the volume of blood flow, thus the erection is able to produce.
What is the treatment procedure?
| 1. | EDSWT is applied on the penile shaft and corpus. The shockwaves in the applicator release strong impulse forces and kinetic energy, to stimulate blood flow. |
| 2. | Using ultrasound gel as medium, the applicator focuses on 5 different anatomical sites. Each site is treated for 3-minute in which 300 shockwaves are delivered. Each treatment session is around 20 minutes. |
| 3. | There will be 2 treatments per week for 3 consecutive weeks followed by a 3 week rest period. |
| 4. | Treatment starts again on week 7 to week 9. The duration of the entire course of treatment is 9 weeks. |
| 5. | According to a clinical study, it shows significant improvement after the treatment period. |
Who can benefit from EDSWT?
- Patients who suffered from erectile dysfunction (ED) for more than 6 months
- Attempted intercourse 4 times on 4 different days and had an unsuccessful rate of more than 50%
- Patients who completed the International Index of Erectile Function (IIEF) and had a domain score at 6 to 20 (denoting mild to moderate ED)
- Patients who completed Rigidity Scale (RS) and score is ≤ 2 (denoting slight to moderate rigidity)
- Patients who have non-neurological pathology
In what kind of circumstances are the patient not recommend for EDSWT?
Clients having the following complications in addition to erectile dysfunction are not recommended to undergo the EDSWT:
- Prior prostatectomy surgery
- Any cause of ED other than vascular related
- Any unstable medical, psychiatric, spinal cord injury, penile anatomical abnormalities
- Clinically significant chronic hematological disease
- Cardiovascular conditions that prevent sexual activity
- History of heart attack, stroke or life-threatening arrhythmia within the prior 6 months.
- Cancer within the past 5 years.
- Anti-androgens, oral or injectable androgens
- Use of any treatment for ED within 7 days of screening
Highlights of EDSWT
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Reference
| 1. | Aicher A, Heeschen C, Sasaki K, Urbich C. Low-energy shock wave for enhancing recruitment of endothelial progenitor cells: a new modality to increase efficacy of cell therapy in chronic hind limb ischemia. Circulation. 2006;114:2823-30 |
| 2. | Vardi Y, Appel B, Jacob G, Massarwi O, Gruenwald I. Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile dysfunction. Eur Urol. 2010;58(2):243-8 |
| 3. | The effect of low intensity shockwave therapy for erectile dysfunction (ED) in patients not responding to phospho- diesterase 5 (PDE5) inhibitors, The Journal of Sexual Medicine, 2010;7(suppl 6):403-464 |
| 4. | Vardi Y, Appel B, Kilchevsky A, Gruenwald I. Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? Short-term results of a randomized, double-blind, sham controlled study. J Urol, 2012 May;187(5):1769-75 |
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Press Clipping
Source: Sharp Daily | Published Date: 12-3-2012
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Oral medication is the most common and convenient treatment option for patients. To date, approved oral medications for erectile dysfunction are sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). They belong to a class of drugs called selective enzyme inhibitors which block the enzyme phosphodiesterase-5 (PDE5). Blocking this enzyme helps maintain levels of cyclic guanosine monophosphate (cGMP), a chemical produced in the penis during sexual arousal. Balanced levels of cGMP causes the smooth muscles of the penis to relax and increases blood flow.
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Mechanism of erection and oral medication
During arousal the following occurs:
- The man's central nervous system stimulates the release of a number of chemicals, including nitric oxide (NO), the main contributor for eliciting and maintaining erection.
- Nitric oxide stimulates production of cGMP, a chemical that relaxes the smooth muscles in the penis. Smooth muscle relaxation allows blood to flow into the tiny pool-like cavernous sinusoids, resulting in increased rigidity of the penis.
- This increased blood flow nearly doubles the diameter of the cavernous sinusoids.
- Penile veins surrounding the chambers are squeezed almost completely by this pressure.
- The veins are unable to drain blood out of the penis and so the penis becomes rigid and erect.
After ejaculation or arousal, cGMP is broken down by an enzyme called phosphodiesterase-5 (PDE5), and other compounds are released that cause the penis to become flaccid (unerect) again. PDE5 inhibitor helps maintain erection b inhibiting the action of PDE5. Since there is no activation of the NO/cGMP system in the absence of sexual stimulation, taking those oral medication does not independently cause an erection.
Higher-Risk CandidatesSome patients are not suitable for oral ED medications. Men with the following conditions should not take PDE inhibitors without the recommendation of their physicians:
- Patients taking nitrate for treating angina, and/or alpha-blockers (except Flomax 0.4mg once daily) for treating hypertension and benign prostatic hyperplasia (BPH).
- Severe heart diseases, such as unstable angina, a history of heart attack, or arrhythmias. Sildenafil increases nerve activities associated with cardiovascular function, especially during physical and mental stress. Men with heart disease may benefit from an exercise test to determine whether resuming sexual activity increases their risk of a heart attack.
- Recent history of stroke.
- Hypotension (very low blood pressure).
- Uncontrolled diabetes.
- Uncontrolled hypertension.
- Taking anticoagulant therapy.
- Severe heart failure.
- Retinitis pigmentosa. (Patients with this genetic disease do not produce phosphodiesterase-5 and do not respond to sildenafil.)
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MUSE - Medicated Urethral System for Erections
The MUSE system delivers alprostadil through the urethra. It works in the following way:
- The drug delivery device is consisted of a thin plastic tube with a button at the top.
- Insert the tube into his urethral opening right after urination. It is suggested to insert after urination, as urinating or urine leakage after administration may reduce the dose.
- Press the button to release a pellet containing alprostadil.
- The man rolls his penis between his hands for 10 to 30 seconds to evenly distribute the drug. To avoid discomfort, the man should keep the penis as straight as possible during administration.
- Keep an upright posture, by sitting, standing or walking for about 10 minutes after administration. By that time, an erection that lasts between 30 to 60 minutes is likely to be achieved. If a man lies on his back too soon after administration, blood flow to the penis may be decreased and the erection may not occur.
- The erection may persist after orgasm.
Specific reports of side effects using the MUSE system include the following:
- Up to 31% of MUSE administrations result in a burning sensation in the urethra.
- Penile pain.
- About 3% of patients experience low blood pressure, which can cause dizziness or fainting.
- Drug interactions. Taking certain cold and allergy remedies may offset the effects of the MUSE-administered drug.
- Other side effects include minor bleeding or spotting, redness in the penis, and aching in the testicles, legs, and area around the anus.
The MUSE system should not be used more than twice a day and is not appropriate for men with abnormal penis anatomy.
Using a vacuum tube is another way to achieve an erection. The penis is inserted into the tube when using. As air is pumped out of the tube, the volume of the penis expands due to influx of blood into the organ under decreased air pressure in the tube. The penis then becomes erect. A specially designed constrictor (like a rubber band) is tied at the base of the penis to prevent the blood from flowing out. The pressure of the constrictor could cause discomfort during ejaculation.
Source: National Institute of Diabetes and Digestive and Kidney Diseases
When other treatment options fail, some patients would receive a surgery to treat ED. A surgeon can implant a device that can be manipulated to inflate or deflate to acheive an erection. Two tubes are inserted into the penis and connected to a reservoir plus an external pump. This operation cannot be reversed, i.e. the implant is not removable. Once a man has a penile implant, he must rely on the device erections in future. Therefore, it is important to talk with the doctor about the pros and cons of having a penile implant.
Structure of a penile implant. Once switched on fluid from the reservoir will be pumped into the rods to inflate the penis.
Source: National Institute of Diabetes and Digestive and Kidney Diseases
There is no best method ED treatment. A combination of the above methods may be prescribed sometimes for the best result.
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Lifestyle of any individuals should be assessed for any potential risk for ED. Doing more exercises, quit smoking, losing weight, and cutting back on alcohol help solve erection problems to some extent in some patients.
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For further information or to make an appointment, please call MHS on (852) 2375-3322.