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What complaint did our patient present with?
Our 54-year-old patient, who had had diabetes for many years, presented to our clinic due to progressively worsening erectile dysfunction. The erectile problem affected both his ability to achieve an adequate erection and to maintain the erection during sexual intercourse.
The patient had previously been evaluated at different centers and, because his erectile dysfunction was considered severe, penile prosthesis surgery had been recommended.
At the time he presented to our clinic, he stated that although he was regularly using PDE-5 inhibitor erectile dysfunction medications, he was no longer obtaining sufficient benefit from them.
How did we develop our treatment plan?
Before undergoing penile prosthesis surgery, our patient wanted to evaluate non-surgical options. Following the assessment, we discussed in detail with the patient the available treatment alternatives, their levels of scientific evidence, and their possible outcomes.
We planned a combined treatment program for the patient:
- 12 sessions of low-intensity shock wave therapy (Li-ESWT)
• 2 sessions of exosome injections
The aim during the treatment process was not merely to temporarily produce an erection, but to improve erectile function in the penis as much as possible.
What changed after treatment?
Following completion of the treatment program, a marked clinical improvement was observed in the patient’s erection quality.
One of the most important points was that the patient was able to achieve an erection sufficient for sexual intercourse without using the erectile dysfunction medications that he had previously needed regularly.
Thus, in this particular patient, although penile prosthesis surgery had previously been recommended, there was no need to proceed to surgical treatment.
Follow-up after 1 year
Our patient returned to our clinic for his 1-year follow-up after treatment.
Two important findings were particularly noteworthy at the follow-up:
He stated that his morning erections were continuing and that he was satisfied with the quality of his erections.
He also stated that the rigidity he achieved during sexual intercourse and his ability to maintain the erection were at a satisfactory level.
Moreover, he was able to maintain this result without regular use of PDE-5 inhibitors.
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What does this case show us?
Diabetes is one of the most important causes of erectile dysfunction and can make treatment more difficult in the long term because of damage to vascular and nerve structures. Particularly in patients who do not obtain an adequate response to oral medications, more advanced options such as injection therapies or penile prosthesis may be considered.
However, it may not be necessary to proceed directly to surgical treatment in every patient.
In this case, following combined treatment consisting of 12 sessions of Li-ESWT and 2 sessions of exosome therapy, we observed that a diabetic patient who had previously not obtained sufficient benefit from PDE-5 inhibitors and had been advised to undergo penile prosthesis surgery was able to achieve satisfactory erections without medication, and that this clinical benefit continued at the 1-year follow-up.
Of course, this result represents the clinical experience of a single patient and does not indicate that the same result will be achieved in every patient.
Therefore, the most important point in the treatment of erectile dysfunction is to accurately evaluate the underlying causes and severity of the condition and to plan treatment individually for each patient.
