Posts Tagged ‘penile pump’

The Penis Pump (Vacuum Erection Device): What You Need To Know

April 8, 2017

Andrew Siegel MD  4/8/17

The vacuum erection device (VED) is an effective means of inducing a penile erection suitable for sexual intercourse–even in difficult to treat men who have diabetes, spinal cord injury, or after radical prostatectomy for prostate cancer.  The device is also useful in the post-operative period following radical prostatectomy to maintain penile length and girth. It has some utility in Peyronie’s disease patients in order to improve curvature, pain and maintain penile dimensions. It can be used prior to penile prosthesis surgery in order to enhance penile length and facilitate the placement of the largest possible implant.  

VED

Image Above: Vacuum Erection Device (obtainable via UrologyHealthStore.com–use promo code UROLOGY 10 for 10% discount and free shipping)

Introduction

Tissue expansion is local tissue enlargement in response to a force that can be internal or external.  Internal tissue expansion occurs naturally with pregnancy, weight gain and the presence of slow growing tumors. Plastic surgeons commonly tap into this principle by using implantable tissue expanders prior to breast reconstructive surgery.

The VED uses the principle of external tissue expansion by using negative pressures applied to the penis to stretch the smooth muscle and sinuses of the penile erectile chambers. The resultant influx of blood increases tissue oxygenation, activates tissue nutrient factors, mobilizes stem cells, helps prevent tissue scarring and cellular death and, importantly, induces an erection.

There are many commercially available VEDs on the market, which share in common a cylinder chamber with one end closed off, a vacuum pump and a constriction ring.  The penis is inserted into the cylinder chamber and an erection is induced by virtue of a vacuum that creates negative pressures and literally sucks blood into the erectile chambers of the penis. To maintain the erection after the vacuum is released, a constriction ring is applied to the base of the penis.  The end result is a rigid penis capable of penetrative intercourse.

Interesting factoid: Similarly designed vacuum suction devices are available for purposes of nipple and clitoral stimulation.

Brief History of VED

In 1874, an American physician named  John King came up with the concept of using a glass exhauster to induce a penile erection. The problem with the device was the loss of the erection as soon as the penis was withdrawn from the exhauster. In 1917 Otto Lederer introduced the first vacuum suction device.  After many years of quiescence, the VED was popularized by Geddins Osbon and named “the Erecaid device.” Currently, the VED is a popular mechanical means of inducing an erection that does not utilize medications or surgery.

Nuts and Bolts of VED Use

The VED is prepared by placing a constriction ring over the open end of the cylinder. A water-soluble lubricant is applied to the base of the penis to achieve a tight seal when the penis is placed into the cylinder.  Either a manual or automatic pump is used to generate negative pressures within the cylinder, which pulls blood into the penis, causing fullness and ultimately rigidity. Once full rigidity is achieved, the constriction ring is pushed off the cylinder onto the base of the penis. Importantly, the ring should never be left on for more than 30 minutes to minimize the likelihood of problems. After the sexual act is completed, the constriction ring must be removed.

Interesting Factoid: The VED can be used alone or in combination with other forms of treatment for ED, including pills (Viagra, Levitra and Cialis), penile injection therapy and penile prostheses.

Pluses and Minuses of the VED

A distinct advantage of the VED is that it is a simple mechanical treatment that does not require drugs or surgery.  Disadvantages are the need for preparation time, which impairs spontaneity.  Another disadvantage is the necessity for wearing the constriction device, which can be uncomfortable and can cause “hinging” at the site of application of the constriction ring resulting in a floppy penis (because of lack of rigidity of the deep roots of the penis) as well as impairing ejaculation. Other potential issues are temporary discomfort or pain, coolness, numbness, altered sensation, engorgement of the penile head, and black and blue areas.

VED After Radical Prostatectomy

Erectile function can be adversely affected by radical prostatectomy with recovery taking months to years. The VED can be used to enhance the speed and extent of sexual recovery after surgery, minimize the decrease in penile length and girth that can occur, and enable achievement of a rigid erection suitable for sexual intercourse.  Clinical studies have clearly demonstrated that VED use after prostatectomy helps maintain existing penile length and prevents loss of length.

Bottom Line:  The VED is one of the oldest treatments for ED that remains in contemporary use.  It works by creating negative pressures that cause an influx of blood into the penile erectile chambers resulting in penile expansion and erection.  Although effective even in difficult to treat populations, the attrition rate is high, perhaps because of the cumbersome nature of the device and the preparation regimen and time involved. However, the VED is an important part of the “erection recovery program” (penile rehabilitation) after prostatectomy, second only to oral ED pills in use for this purpose. It is particularly vital in the preservation and restoration of penile anatomy and size.  It also is useful in ED related to other radical pelvic surgical procedures including colectomy for colon cancer. It remains a viable alternative in men not interested or responsive to ED pills or penile injections and those not interested in surgery.

There are many different VED systems on the market. The Urology Health Store (www.UrologyHealthStore.com) has a nice selection of VEDs (use promo code UROLOGY 10 for 10% discount and free shipping).

** The Urology Health Store  is offering live video VED instructional classes via Skype, Go-To-Meeting or FaceTime.  These classes are available by appointment from 1PM-3PM, U.S. Eastern Time, Monday-Friday.  Call 301-378-8433 for appointment.  No purchase is necessary to take the class.

Excellent resource: External Mechanical Devices and Vascular Surgery for Erectile Dysfunction.  L Trost, R Munarriz, R Wang, A Morey and L Levine: J Sex Med 2016; 13:1579-1617

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

Penile Implants

February 27, 2016

Andrew Siegel MD 2/27/16

With respect to male sexual dysfunction,  implantation of a penile prosthesis is a highly effective procedure capable of restoring erectile function in those men who do not respond to simpler treatment measures.  In many ways it is as quality-of-life-restoring as a total knee replacement is to one suffering with arthritis, converting a penile “cripple” into a functional male with restored erections and resolution of the psychological and emotional devastation resulting from loss of manhood.

There are two principles that can be pretty much applied to all situations in life:

  1. If it ain’t broke, don’t fix it. (Pardon the English.)
  2. If it is broken, try the simple and conservative before the complex and aggressive.

These concepts are commonly applied to medical issues in general and male sexual dysfunction in specific.  If erections are satisfactory, no treatment is necessary (but maintaining a healthy lifestyle will sure help keep things that way).   However, if erections are flimsy and feeble, the following sensible tiered strategy is in order:

First-Line Approach

Lifestyle makeover. This includes a heart-healthy (and penis-healthy) diet, getting down to “fighting” weight, exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc. Aside from general exercises (cardio, core, strength training, flexibility), specific pelvic floor muscle exercises (“man-Kegels”) are beneficial to improve the strength, power and endurance of the penile “rigidity” muscles.

Second-Line Approach

ED meds/Penile vibratory stimulation therapy/Penile pump.  Viagra, Cialis, Levitra and Stendra are pharmacological options.  As an alternative to medications, penile vibratory nerve stimulation (Viberect device) can be an effective means of helping resurrect erectile function. Alternatively, the vacuum suction device is a means of drawing blood into the penis to obtain an erection; the system uses a constriction band to maintain the erection.

Third-Line Approach

Urethral suppositories/Penile injection therapy. Suppositories are medicated pellets that are placed in the urethra (urinary channel) that  increase penile blood flow and induce an erection. Penile injections of vasodilator medications do the same and more effectively so, but require the medication to be injected directly into the penile erectile chambers. (Blog on this subject forthcoming next week.)

Fourth-Line Approach

Penile implant. This is a device made of synthetic materials that is surgically implanted under anesthesia, typically on an outpatient basis. It is totally internal, with no visible external parts and aims to provide sufficient penile rigidity to permit vaginal penetration. For the right man under the appropriate circumstances the penile implant can be a life changer.

There are two types of penile implants: semi-rigid and inflatable. I liken the difference between these two implants to the distinction between a Volkswagon and Mercedes, both effective and functional, but one with many more “bells and whistles.”

A semi-rigid penile implant (a.k.a. malleable implant) is a “static” implant that always remains rigid, not unlike the os penis (penis bone) present in many primates, except that this implant can be hinged. It is bent upwards to put it to use and is bent downwards to conceal it. It consists of two cylinders that are implanted within the penile erectile chambers through a small incision.

Print

(Coloplast semi-rigid penile implant)

The advantage of the semi-rigid implant is its simplicity, the fact that it is less expensive than an inflatable device and its utility for handicapped patients with dexterity issues or those who have limited reaches. Its disadvantage is that it cannot go from a flaccid state to an inflated state as can the inflatable penile implant, thus creating some potential issues with concealment. Furthermore, by virtue of the constant pressure of the implant on the soft tissues of the penis, it can be more uncomfortable than the inflatable variety and has the potential for thinning the penile flesh.

The inflatable penile implant (IPP) is a “dynamic” device designed to mimic the characteristics of a normal erection, with the capacity to inflate and deflate by virtue of a self-contained hydraulic system. Dual cylinders (inner tubes) are implanted in the erectile chambers. The length of the erectile chambers is precisely measured in order to size the implant properly, similar to measuring the size of your feet in order to ensure a good shoe fit. A control pump is implanted in an accessible area of the scrotum. The third element is the reservoir, which contains the fluid necessary for inflation. The reservoir is typically implanted behind the pubic bone or within the abdominal wall. Tubing connects the control pump to the cylinders and to the reservoir.

Titan Touch product anatomy

(Coloplast inflatable penile implant)

When an erection is desired in a man who has an IPP implanted, the scrotal control pump is repeatedly squeezed, which transfers saline from the reservoir into the penile cylinders. As the cylinders fill, an erection develops and with each consecutive squeeze, more fluid is flows into the cylinders, creating a more rigid erection of wider girth. The erection will remain until the release bar on the control pump is activated.   After the completion of sexual intercourse, by activating this release bar, the fluid in the cylinders returns to the reservoir where it is again stored, returning the penis to its flaccid state. Some IPPs are designed to increase in girth only, whereas others can increase in length and girth.

IPPs have been available for over forty years and have been improved remarkably over the years. The current devices are well-engineered, sophisticated,  highly effective devices. Penile sensitivity, sex drive and ability to ejaculate are essentially unchanged following an IPP implantation. It is important to know that unlike a normal erection, the IPP erection does not result in swelling of the head of the penis nor the erectile tissue surrounding the urethra. Nonetheless, it results in a penetrable and durable erection that can restore sexual function in a man who is incapable of achieving an erection.

Advantages of the IPP are its ability to inflate and deflate, creating no issues with concealment. The penis can be kept inflated for as long as desired, whether it be 60 seconds or 60 minutes and will not deflate after ejaculation, unlike what typically occurs under normal circumstances. Disadvantages include its additional expense (although it is usually covered by insurance), the fact that it requires some degree of manual dexterity to operate, and the fact that it is more susceptible to mechanical malfunction than the semi-rigid variety because of its complexity.

Bottom Line: The penile implant is a fourth-line approach for ED that is a highly effective means of providing erectile rigidity on demand, capable of restoring sexual function in a man who is incapable of achieving a functional erection.

Thank you to the Coloplast Corporation for providing the images.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Arnold Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store that is home to quality urology products for men and women.  Use code UROLOGY10 at check out for 10% discount.