The role of vacuum erection devices in penile rehabilitation after radical prostatectomy

Abstract

Even nerve-sparing radical prostatectomy damages the cavernous nerves and leads to temporary erectile dysfunction (ED) in men recovering from prostate cancer surgery. Historically, patients recovering from prostate cancer surgery have been advised that the return of erectile function (EF) can take from 6 to 18 months, or even longer. Unfortunately, the return of sexual function in these patients remains variable, but is generally thought to be dependent on the individual patient's pre-surgery EF, as well as the degree of cavernous nerve disruption during prostate removal. Recently, there has been a growing movement to proactively treat patients postoperatively for presumed nerve damage to stimulate nerve recovery and possibly reduce the degree of irreversible damage. This would reduce the on-demand therapy these patients would require, and hopefully remove the requirement for an implantable prosthesis. The underlying hypothesis is that the artificial induction of erections shortly after surgery facilitates tissue oxygenation, reducing cavernosal fibrosis in the absence of nocturnal erections, potentially increasing the likelihood of preserving EF. Vacuum erection devices (VED), because of their ability to draw blood into the penis regardless of nerve disturbance, have become the centerpiece of penile rehabilitation protocols. This review will discuss the pathophysiology of radical prostatectomy induced ED and the rationale for rehabilitation. It will then discuss current protocols, including those involving the VED.

Vacuum therapy in erectile dysfunction—science and clinical evidence

“…80 There has been growing evidence to support this. Blair et al 81 documented that sub-atmospheric pressure induces an initial increase in arterial inflow in the forearm of healthy volunteers; Greenfield and Paterson 82 further showed a vasodilation effect on the arteries of the forearm in volunteers exposed to a subatmospheric pressure of À150 to À200 mm Hg, which is similar to the pressure used in VED.…”

“…There have been theories that PDE 5 I may work through a separate, neuron-independent endothelial cell mechanism; however, it is still unproven. 80 The direct mechanism of VED circumvented this limitation. Given its low complication rate and relatively high compliance rate, along with being the only modality that preserves penile length, VED is an ideal choice as PR after RP 80 or other pelvic injuries.…”

“…80 The direct mechanism of VED circumvented this limitation. Given its low complication rate and relatively high compliance rate, along with being the only modality that preserves penile length, VED is an ideal choice as PR after RP 80 or other pelvic injuries. 97,98 Munding et al 99 documented that up to 48% men had considerable shortening of the stretched penile length (greater than 1.0 cm) at 3 months after RP.…”

Combined sildenafil with vacuum erection device therapy in the management of diabetic men with erectile dysfunction after failure of first‐line sildenafil monotherapy

“…To EDDM patients, the mechanism of PDE5i plus VED therapy can circumvent the limitation of monotherapy. Since the hypoxia caused by microvascular deficit is the trigger leading to a series of events that eventually cause irreversible damage, we then used VED to simulate natural erection half an hour every day, which allows reoxygenation of the penis . The increased arterial inflow in the penis increased the cavernosal tissue oxygen levels, which effectively alleviated the tissue hypoxia damage caused by cavernous nerve injury, inhibiting tissue cell apoptosis, preventing cavernosal tissue fibrosis and allowing adequate stimulation of nitric oxide synthase to produce nitric oxide.…”

An Unusual Case of Neurogenic Sexual Dysfunction Due to Lead Exposure

“…The central and peripheral neurologic pathways involved in sexual function include brain centers, spinal cord, cavernous nerves and pudendal nerve [10]. Anatomy of the cavernous nerves are mixed autonomic nerves that is responsible for penile erection, ejaculation and detumescence [11]. The pudendal nerve plays an essential role in pudendal evoked potentials, last phases of penile erection, threshold of somatosensory reflexes and ejaculation [12].…”