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Dr. Faysal Yafi Discusses Restoration of Erectile Function

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The UCI Susan Samueli Integrative Health Institute welcomed Dr. Faysal Yafi, a urology associate professor and UCI Medical Director of Urology in the Men’s Health Program at the UCI Medical Center, for a virtual webinar called “Turning Back the Clock: How to Restore Erectile Function” on Oct. 28. In this webinar, Yafi discussed erectile dysfunction and how men today look to “turn back the clock” to restore their sexual health.

This event continued the “Integrative Insider LIVE!” series, monthly talks with the UCI Health patient community that aim to educate individuals on medical departments and their roles in integrative medicine. 

Dr. Jacob Hwang, a specialist in naturopathic medicine at the UCI Susan Samueli Integrative Health Institute, began the webinar by introducing Yafi who then opened the discussion by introducing the topic of erectile dysfunction and the importance of facilitating a conversation about this theme. 

“Erectile dysfunction is very common. The likelihood of the condition increases with age, where 50% of men at age 50 years old have erectile dysfunction (ED). By every decade, the percentage of cases and severity increases,” Yafi said.

Yafi explained that young men with the condition can benefit more from treatment options in comparison to older men because of their age. However, Yafi believed this difference in efficacy is not driven by the process of aging itself.

“This is most likely because of lifestyle and health issues that a man will go through as he gets older,” Yafi said. 

As urologists, Yafi stated that their goal is to treat men who have severe ED but also help prevent the condition from occurring among older men or developing into a more severe form of the condition. 

Yafi explained various treatment options for ED, beginning with dieting. 

“There are 13 studies on diets and ED and 15 studies on diet and testosterone levels. What they show is that ED appears to lessen in men adhering to the Mediterranean diet; this is probably because this diet is opposite to what we call a Saturday American diet. Instead of containing processed foods, the Mediterranean diet is based on vegetables and grains,” Yafi said.

Another treatment option were PDE5 inhibitors. 

“The problem with these pills is that there is a 30 to 40% response to them. There is also a 45% to 80% drop-out rate, so not everybody who goes into these pills has the pills work for them,” Yafi said.

Although the treatment option of diet changes and PDE5 inhibitors have shown particular success, Yafi mentioned that these options don’t lead to the results men are actually interested in. 

“In a study, the first question that was asked involved the importance ranking of success outcomes for patients. The most important thing that patients wanted was a cure. Every single option I have shown so far is not a cure. Every single option is putting a band aid as a temporary solution,” Yafi said.

With the desire of “turning back the clock” to a time where they had optimal erectile function, men have the chance to return to an ecstatic period in their sex lives with newer options of restoration via regenerative therapies, including stem cell therapy, platelet-rich plasma (PRP) injection and shockwave therapy. 

“Interest in stem cells has grown since the early 2000s. There is some good evidence for benefit in some medical conditions like eyes, bones, muscles, hair, etc.,” Yafi said. “But there is insufficient evidence of efficacy and safety to improve erectile function.”

Stem cell therapy could be the future of restoration in ED; however, Yafi cautioned patients from using this costly method. Platelet-rich plasma injection, in comparison, is the most popular among patients today. 

“What happens in PRP is that samples of blood are collected from patients. Professionals separate the platelets in the blood into a centrifuge that isolates platelet rich plasma. This plasma is then injected into the affected area,” Yafi said. 

The downside to this method, like with stem cell therapy, involves the lack of evidence that demonstrates safety and efficacy to improve ED. Today, Yafi claimed that the most beneficial regenerative therapy is shock wave therapy. 

“In the ‘80s, urologists were the first to introduce shock wave therapy, which encompasses strong ultrasound waves that are delivered from the outside of the body, to treat renal stones,” Yafi said.

The U.S. is one of many countries where companies use marketing tactics and advertise for false products and procedure placement regardless of not having sufficient scientific evidence to prove that such products provide promising results. Shock wave therapy was one procedure that fell victim to false advertising from companies like GAINSWave and The Phoenix. 

“GAINSWave is everywhere. On the radio, there is a person who advertises delivering sound wave therapy to the penis to improve erections on just about every corner. Since you don’t need a medical license to do GAINSWave, there could be hairdressers . . . or florists doing GAINSWave,” Yafi said. 

With the appeal of money, products like The Phoenix suggest the same results. 

“The Phoenix is a portable shock wave device that you can bring to your own house,” Yafi said. “You can have fun with your partner, shocking your penis to try to prove your erection.” 

However, these methods like the GAINSWave do not show any signs of ED improvement. 

To explain why such procedures do not function, Yafi continued his discussion by explaining the differences between radial (acoustic) waves and focal (shock) waves. 

“Not all ultrasound waves delivered are shockwaves. Shock waves peak at an earlier time, and this is what you want. A very strong pressure to start over a short period of time that should go deep into the tissues like a burst of energy. Radial (acoustic) waves don’t demonstrate the same results, having lower depths of penetration,” Yafi mentioned. 

At the UCI Medical Center, shockwave therapy has become a successful treatment for ED in their male patients. Yafi went on to describe UCI’s protocol for the procedure. 

“We have a device named UroGold 100, which is probably the best device that is available on the market. We do treatments using an ultrasound device on the top of the penis, bottom of the penis, and on both sides of the penis. We then lift the penis on the scrotum up into the sky and then go below to the base of the penis and up to the gluteus maximus,” Yafi said. 

With six weekly treatments and 3,000 shocks per treatment, each procedure lasts around 15 to 20 minutes and has no restrictions post-procedure. Based on the results of a study using the therapy, Yafi reported successful restoration of erectile function through erection hardness scores. 

“The erection hardness score is another questionnaire that is my favorite. Since there are four types of erections men can get (soft, semi soft, semi hard, and hard), patients want to be in groups three or four, which depict harder erections,” Yafi said. “The majority of our patients had a one-point increase in their score. We are basically able to convert patients who are unable to penetrate into patients who can.” 

While erectile dysfunction is a common medical condition, reactive treatments options are available to use and improve men’s lives. 

Korintia Espinoza is a STEM Intern for the fall 2021 quarter. She can be reached at korintie@uci.edu.