So now a couple of words on what else is out there. The sexual medicine has always been
the wild west, right? I mean, we know about that everything from traditional Chinese medicine
and rhino horns and deer antler extract, and all of the stuff that's out there in supplement
form, and certainly alternative medicine—some of it legal, some of it not so legal, so let
me break down a few of the big ones out there and what I think about them—just as somebody
that maybe has a little more inside knowledge.
So everybody, who's heard of this? Low-intensity shockwave therapy. Has anybody? Show of hands?
So not too many out there (LISWT). It's very interesting. So the Sexual Medicine Society
of America, which is kind of an offshoot of my big professional society, the AUA, we just
had a big fight/meeting or meeting/fight about this. There are believers and non-believers,
there's literature for and against. So let me just give you a background of the technology
of what this is. Essentially, what we know—anybody ever had a kidney stones? Lots of kidney stones?
I've had one, they're terrible, right? Anybody ever had lithotripsy where they had shocked
the kidney stone out? So, same technology. So here's the story, the shock, the idea of
shockwaves goes back to about the 1940s. The Russians actually figured it out when we started
to break the sound barrier at supersonic speed planes would come back, they'd land, and their
entire fuselage would be filled up with little pings (ping, ping, ping, ping). So you hear
those sonic booms, that sonic boom translates into a physical force. So, through about 40
years of research, there were able to get that physical force down into a large machine
which we could then target to break up kidney stones. The shockwaves hit the kidney, they
passed pretty harmlessly through the kidney and they broke the stone. But they didn't
pass totally harmlessly through the kidney. So when we looked at guys after shockwave
therapy, we looked at their kidneys, we found what happened was something called endothelial
cell proliferation. So, a kidney in a guy that had been treated for stones has way more
blood cells or blood vessels rather than the kidney that was not treated with shockwaves.
So, some very thoughtful Israeli scientists said well geez, we want more blood vessels
in the penis. Why don't we just start shocking a bunch of penises and see what happens? And
that's what they did about 15 years ago in animal studies, and now human studies, which
in the United States are kind of not super big randomized controlled trials. So at this
point, in the United States, LISWT is still considered fringe medicine. Not FDA-approved,
will probably never be FDA-approved for a number of reasons, but very safe. European
Sexual Medicine guidelines actually put this as first-line therapy, probably even safer
than Viagra and Cialis and the pills. So a lot of—this is available in the United States,
it's always going to—not always—but it's a cash paid procedure. The costs vary depending
on who's selling it to you. But certainly has some literature and there might be a little
bit more of a swelling of interest. It has been studied in men post-prostatectomy to
be safe and effective, but again, it's still not primetime in the United States. But that's
probably the sexiest of all of the things I'm going to talk about in terms of the literature,
the data, and the science.
P-shots or PRP platelet rich plasma, this is, a thought is that you're taking cells
that can generate more blood vessel flow by removing your own blood, centrifuging it,
taking off the top layer (we call it the supernatant), and then injecting it back into the guy's
penis. Huge business in this country, huge, huge business. Data still not out there that
it does anything, unfortunately, although if you look at just prospective studies, prospective
studies with P-shot show efficacies of 30-40% and upwards. Anybody know, so Viagra came
out in 1998, studied for 10 years before that. So, the placebo arm of Viagra, where the guys
took a sugar pill, and they reported how good their erections were. Anybody know how many
guys had better erections in the placebo arm of the Viagra clinical trials? Anybody want
to guess? Just yell out a number.
20%
20%, pretty good. Yeah, it's almost 38%, so yeah. So, if you take, if I give you a green
M&M and tell you this is the best boner pill you're ever going to see (I just kind of rub
the M off of it) and you believe me because I'm a really convincing doctor and I've got
amazing qualifications and I'm a UCLA professor, then I've got a between 20% and 38% chance
that you're going to get a great erection because there is an ability for our mind to
control our body, there's no doubt about it. And I'm not saying that's anything against
P-shots, but I'm saying that you have to work pretty hard in a randomized control trial
to beat placebo in something like this.
Same thing with stem cells and cord bloods. Now, I will tell you a thing about stem cells.
Stem cells really, in some ways, can be the future of medicine. We're using them—we're
looking in orthopedics, we're looking at in cardiovascular regeneration. Here's the problem
with stem cells, and there's a lot of stem cells clinics that are getting opened and
shut down at the same time across the country. Here's the problem with stem cells from a
scientific standpoint. If I take a stem cell, whether I get it from fat or bone marrow or
anywhere else that generates these primordial cells, if I don't have a scaffold, if I don't
have some kind of matrix for that cell to grow on your body is just gonna piss it away,
quite literally. So the problem with stem cells now, wherever we get them from, is if
you inject it into whether it's a knee or a penis, it's hard for it to stay where it
wants to go. So we need to develop, and that's what we're working on. So Wake Forest University
and UCLA we're kind of partnering on a potential big grant to look at stem cells where we have
to build the biologic matrix in the penis for those stem cells to adhere to, and then
we might find something. But the kind of stem cells that people are probably trying to sell
on your street corner stem cell injection clinic don't have that biologic matrix. So
just remember that, the idea of stem cells, very promising, very interesting, but you
have to have the tissue engineering for those stem cells to actually do what you want them
to do and differentiate into new penis tissue. Same thing with cord blood injections. Really
interesting, very compelling, but the randomized trials aren't there, and therefore it's a
little bit hard to come up with a scientific opinion on that.
So all kinds of supplements out there. I won't spend any time on this because, again, we've
got the supplement guru in the front row here, but there are ones that work and there are
ones that are studied and I think this audience is pretty familiar with them, and I'm not
a naysayer in that.
And then I love sex therapy, I mean whether I do or not, I don't know, but I love my patients
to go through sex therapy. I think that this is something that is not well used by the
medical community, but sex therapists are fantastic and they're great at talking about
what if, now what if a guy is never able to get another erection? Right? So my job as
a penis doctor is that I want you to walk out of my office or my operating room with
the best erection that you and your partner can enjoy. That would be great, right? That
doesn't happen. We have complications. We have guys that are never going to get another
erection. Doesn't mean you can't stop having sex, right? There are so many different ways
to be sexual that are beyond what I can teach as a physician or as a surgeon, and that's
why I love my sex therapy community. It's truly a critical part of—especially—couples
dealing with this. So find a good one.