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Benefits of Using a Penis Pump Before and After Prostate Surgery

Penis Pump before and after prostate surgery


What Is a Radical Prostatectomy?


Radical prostatectomy (prostate surgery to remove the prostate gland) is most often done to treat localized prostate cancer. Less often, a simple prostatectomy is done to relieve symptoms associated with BPH (benign enlargement of the prostate gland). Radical prostatectomy involves removing the entire prostate as well as some of the surrounding tissue, including nerves and lymph nodes.

One of the side effects of prostate surgery is erectile dysfunction. In fact, several studies cite an 85% occurrence rate, which means about up to 9 out of 10 men who undergo this procedure end up with some degree of impotence. Penile rehabilitation refers to therapies that can help preserve penile tissue and restore erectile function in men who have undergone prostate removal.

A vacuum erection device or penis pump is an effective intervention to improve penis health in men with impaired erectile function after surgery. What are the benefits of using a penis pump before and after prostate surgery? Let’s find out.


Why does prostate surgery cause erectile dysfunction?


Why does prostate surgery cause erectile dysfunction?In men with prostate cancer that has not spread outside the gland itself, surgery is often the recommended treatment. Radical prostatectomy involves removing the entire gland along with the seminal vesicles and some surrounding tissue. There are several types of prostate surgery, including laparoscopic and robotic-assisted procedures.

In the retropubic approach, the surgeon makes an incision in the lower abdomen, from the navel to the pubic area. The prostate is carefully separated from surrounding nerves and blood vessels before it is removed along with adjoining tissue. In the perineal approach, an incision is made between the anus and the scrotum.

This is a shorter operation and is preferred when lymph nodes do not need to be removed. However, the perineal approach is associated with a higher incidence of post-surgery erectile dysfunction.

Erectile dysfunction is one of the most common side effects of prostate surgery. Nerves in the penis play a critical role in the development of erections. Two bundles of nerves are present on either side of the prostate gland. Although surgeons take great care to avoid cutting these nerves during the procedure, some degree of damage does occur. This is the reason that erection problems are common after prostate removal even with a nerve-sparing approach.

Not everyone suffers from loss of spontaneous erections after prostatectomy. The ability to have an erection after prostate surgery depends on a number of factors, including:

  • Age
  • Erectile function before the operation
  • The degree of nerve injury during the procedure
  • Type of surgery
  • Experience of the surgeon

Older men are more likely to suffer from erectile dysfunction following prostate removal due to age-related effects. A man’s erectile function before surgery also plays a role, and men with good penis health are more likely to retain erectile ability post-procedure. The type of procedure performed is also important.

Surgeons do their best to preserve the nerves during the surgery, but as noted, the perineal approach is associated with a higher rate of ED. Erection problems are equally common following a laparoscopic approach versus an open approach. However, studies show that robotic-assisted prostatectomy has better erectile function recovery rates.


Should I use a penis pump to help improve penile health before prostate surgery?


A penis pump use is like exercise for the penis. Just like exercising the body is good for overall general health, regular use of a penis pump is good preparation for prostate surgery. Erections occur when an immense amount of blood flows into the penis and engorges it. When the penis remains flaccid for Penis Pumplong periods of time, penile tissue is deprived of oxygen-rich blood.

This leads to a loss of flexibility and scar tissue formation in the corpora cavernosa (the smooth muscles that relax and allow blood to flow into the penis during erections). The resultant inability of the penis to expand leads to erectile dysfunction Simply put, erectile function is a use-it-or-lose-it deal. Using a penis pump before prostate removal can improve penis health.


Why is it recommended to start using the vacuum device before the prostate surgery?


A penis pump or vacuum erection device (VED) consists of an acrylic cylinder that is placed around the penis. When air is pumped out of the cylinder, the vacuum that is created causes blood to flow into the penis, making it rigid and erect. Using a vacuum erection device before prostate surgery, therefore, improves blood circulation, which in turn helps to maintain a healthy penis.

Healthy tissue recovers faster from surgery. A common side effect of prostate removal is penile shrinkage in terms of both length and circumference. Penis pumps help maintain preoperative penis size and minimize the effect of shrinkage following surgery.


How do penis pumps help with penile rehabilitation after prostate surgery?


The nerves in the penis that trigger erections may be damaged during the procedure to remove the prostate. The neuropraxia (temporary loss in nerve function) takes time to recover. This means that the ability to have spontaneous erections after surgery often returns slowly. In fact, it can take several months to years to regain sexual function after prostate cancer. During this time, men are unable to experience even nighttime erections.

Rather than waiting for erectile function to return on its own, doctors feel that regaining erectile function after prostate surgery can be helped along by a penile rehabilitation program. Penile rehabilitation is a type of physical therapy for the penis. Following prostate removal, a penis pump helps recover erectile function by regularly exercising the penis.

This keeps the penile tissue healthy and allows the nerves in the penis to regenerate so that eventually satisfactory erections can occur. Studies show that penis pumps are a safe, well-tolerated, and effective method of penile rehabilitation.

A penis pump creates negative pressure and increases blood flow to the penis. Engorgement of the penis with blood is necessary for strong and long-lasting erections. In addition, the blood flowing into the penis carries nutrients that are essential for a healthy penis. By mechanically pumping blood into the penis, a VED helps preserve the tissue and minimize damage while allowing the nerves time to heal.


How long after the surgery may I start using the penis pump for rehabilitation exercises?


Most men are advised to begin using a vacuum constriction device within two months of nerve-sparing radical prostatectomy. A survey of more than 600 urologists from the American Urological Association showed that the overwhelming majority (97%) of physicians start rehab within four months of prostate surgery.

Authors Dalkin BL and Christopher BA published a clinical study in the International Journal of Impotence Research.  In an article titled Preservation of penile length after radical prostatectomy: early intervention with a vacuum erection device. Sep-Oct;19(5):501-4. Epub 2007 Jul 26. In this article, they describe when the participants of the study used a penis pump for penile rehabilitation.  Daily use of a vacuum erection device was begun the day after catheter removal and continued for 90 days.  It is recommended to work with your physician to determine when to start using the penis pump for rehabilitation exercises. 


How do the results impact penile tissue?


Fibrotic changes (scarring) lead to shortening and decrease in girth of the penis following surgery. Venous leakage from damaged tissues is also thought to play a role in the development of erectile dysfunction after prostate surgery. Penile rehabilitation with a penis pump helps maintain penile length and girth. It also helps with nerve recovery and overall tissue health for quicker recovery.

The authors of a 2016 clinical study determined that the average loss of penile length (penile shortening) after radical prostatectomy was 1.87 cm and 1.82 cm respectively. They further determined that men who use a vacuum erection device that no significant changes in penile length (penile shortening) were observed in men using a vacuum erection device after surgery.


How long does it take to see results?


Results are not immediate and it can take several months to notice a difference. One study found that 17 percent of men had a return of natural erections after using a VED device for nine months. Doctors typically recommend the use of a penis pump for at least 12-18 months after prostate surgery for penile rehabilitation.

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Nocturnal Erections and Penile Health

Nocturnal Erections and Penile Health

Night time


Nocturnal erections


Nocturnal penile tumescence (NPT) is a spontaneous erection of the penis during sleep or when waking up. Several less formal and well-known expressions might be morning hard on, morning wood or descriptions like morning glory all used to describe this natural anatomical process.  Have you ever wondered what causes the phenomenon?


What causes nocturnal erections?


man getting into bedSeveral theories are popular, none entirely proven. One is that spontaneous night time erections may be caused by a full bladder, which is known to cause mild stimulation of a region of the spinal cord containing nerves that control a man’s ability to have so called “reflex” erections.

Some clinical studies suggest testosterone is thought to be at its highest levels in the morning at that this may provide an explanation.  The connection between testosterone levels and nocturnal erections is not very conclusive.

There is evidence that spontaneous erections begin early in the life of males.  Fetal penile erections have been recorded in ultrasound scans so it is difficult to imagine that these types of erections are related in any way to acts of sex, so what physiological role do they play?


Sleep Cycle

REM sleep is associated with spontaneous erections


Most men have 3-5 spontaneous erections during deep sleep.  REM sleep is one of five distinct phases of sleep.  Because sleep cycles repeat, everyone enters REM sleep several times a night.  This is when dreaming is most common.

REM-related erections have been observed in all mammalian species where they were looked for. No-one knows why REM-related erections occur.  So why do men wake up with an erection?


Man waking up in the morning



Why do men wake up with an erection?


Scientific explanations as to why men get erections in the morning may vary, and the absolute cause may not be exactly known.   However, the way scientist and medical doctors use the presence of nocturnal erections as a diagnostic tool is very clear.

A study in the Urologic Clinics of North America noted that Nocturnal Penile Tumescence (NPT) monitoring remains the best single non-invasive examination to distinguish between whether erectile dysfunction or impotence has a physical cause or psychological cause.


Nocturnal penile tumescence test


Nocturnal penile tumescence tests are used to determine if the cause of impotence is physical, psychological, or both.  By determining if men achieve 3-5 erections during rem sleep a physician maybe able to begin the process of understanding how to treat the underlying conditions that have created ED.


The stamp test is one of the most common and simple ways to test for nocturnal penile tumescence. Types of erectile dysfunction tests can vary depending on your symptoms and the recommendation of your doctor.


The chances are if you do not experience nocturnal erections spontaneously during sleep that there is a physical cause to the impotence or ED you are experiencing.  If this is not diagnosed by your physician it’s time to work with your doctor to determine the cause.


Penile Health and exercise


Penis Health


Routine erections in a 24-hour time period are necessary to keep your penis in shape. Penile rigidity and erections bring oxygen to the penis. Use it or lose it is a common term and applies to penile health.

The penis in its flaccid or non-erect state it does not have adequate blood flow and oxygenation to keep penile tissues healthy. Without blood flow every 24 hours in the form of spontaneous nighttime erections penile atrophy, programmed cell death, and penile shrinkage may occur due to the lack of erections.

In a clinical study published in the Journal of Sexual medicine theories that support penile rehabilitation using a vacuum erection device are presented.


Penile rehabilitation


Time to heal stopwatch

Many physicians who treat prostate cancer focus on minimizing the side effects of erectile dysfunction resulting from treating cancer.  Erectile function, including nocturnal erections, may be lost if nerves are severed during removal of the prostate.

Penile rehabilitation is the process of preventing penile atrophy, programmed cell death and penile shrinkage by using a medical intervention to create erections that “exercise” the penis.

The goal of penile rehabilitation is to maintain and create penile health through artificially induced erections so a man may return to natural erectile function when severed nerves heal.  The effectiveness of penile rehabilitation for maintaining and creating penile health is widely debated.

Vacuum erection devices are considered first-line therapies of erectile dysfunction and preservation (rehabilitation) of erectile function following treatment for prostate cancer. 

An erectile dysfunction pump is considered the treatment of choice for penile health and rehabilitation because multiple erections (5-8) can be created and released in one therapeutic session (during a 10 minute session). 

This process is thought to mimic the creation of multiple nocturnal erections that would normally occur during REM sleep in a 24-hour period without the use of drugs or needles.  Thus, it is a natural way to bring blood flow and oxygenation to penile tissues to prevent penile shrinkage, atrophy, and programmed cell death.

Much research and debate will be needed in the future. Will the practice of penile rehabilitation translate to all men who do not achieve nocturnal erections?

Will similar penile rehabilitation treatment protocols be used for men who are diabetic, suffer from metabolic syndrome, or take medications that eliminate nocturnal penile tumescence? 


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Penile Rigidity and Penile Health

Erectile dysfunction is defined as the inability to achieve and maintain an erection that is sufficient for sexual intercourse. For many of the right reasons we focus on erectile dysfunction, or absence of penile rigidity, in terms of how it impacts sexual intimacy and the relationships of couples effected by ED.

You might find it interesting to know there is more to erectile function or penile rigidity than its impact on sexual relationships, emotional well being, and self-esteem.  Beyond psychology, healthy erectile function and penile rigidity may also be important on a physiological basis and maybe on a cellular level.

Consider the following …..

Whether you have normal erectile function or not, most of the time the penis is in a non-erect or flaccid state.

When the penis is flaccid or in a non-erect state it does not receive and hold the same amount of blood as a penis that is rigid or erect.  Like all other organs in the body, an adequate amount of oxygen and blood flow is necessary to keep tissues and blood vessels healthy.

When the penis is erect it is believed that as much as six times the blood flow enters the organ compared to when it is non-erect or flaccid.  The presence of oxygen rich blood flow stretches, expands, and enriches the penile tissues.

Erections, thought by many as simply necessary for sexual intercourse, are also believed by many doctors and medical researchers to prevent tissue atrophy, programmed cell death, and penile shrinkage.  This belief is so because blood flow and erections or penile rigidity occur together.

Because erections are a blood filling process that brings oxygen and nutrient rich blood flow into the organ, the absence of erections may be detrimental to penile tissues.

So the relationship between achieving penile rigidity or erections and penile health on a tissue and cellular level may be intricately related.  Without penile rigidity or erections, the health of penile tissues may be put at risk.