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I have my first appointment with the surgeon / specialist tomorrow. I'm going to ask him if I should use VED before surgery, but I'm curious what the worlds best have suggested to any of you.

Dr Kramer does not lend much credence to the pre-op vacuum prep espoused by Sellers-Dineen, et al, but wrote to me, "I don't think vacuum devices make any difference at all, but if you think it helps, go for it. It can't hurt, I just think not worth the inconvenience. "

I have been stretching by vacuum since December and believe I have positive results. I opine the benefit will depend greatly on your particular deficit(s). Long term ED sometimes results in contracture. Prolonged (more than 2 years or so) contracture (such as complete absence of erections from protatectomy or other reasons) may be hard to reverse, but meduiu term contracture might be able to be stretched out with a VED over a coupld months (as in the SWellers-Dineen paper). Just my lay opinion, bolstered by one man's experience and a bit of research.

Seller-Dineen paper (citation and link are below) told me this:
My own rough summary: 750 patients with long-term ED participated in a 60 day pre-op Vacuum Therapy protocol and were evaluated by post-op size results compared to national averages and prior experience of the participating surgeons. "...larger size cylinders being implanted when compared to our previous implantations absent of the patient participation protocol"

What impressed me most was this: "After the vacuum program, patients tend to experience less pain following implantation allowing earlier device instruction cycling and use."

This meshes nicely with the Caraceni paper describing success in mitigating the "coffin effect" (also known as Pseudo-Capsule Contracture and other names) which recommends early inflation as a means of reducing size loss. The difficulty of early inflation was patient participation hindered by pain while attempting the early inflation protocol.

I speculate that pre-op vacuum therapy would make following the Caraceni protocol much easier. Thereby gaining both sets of benefits.

Citations:


Vacuum Preparation, Optimization of Cylinder Length and Postoperative Daily Inflation Reduces Complaints of Shortened Penile Length Following Implantation of Inflatable Penile Prosthesis

by Tom Sellers, Martin Dineen, Emad A. Salem, Steven K. Wilson: Advances in Sexual Medicine, 2013, 3, 4-18doi:10.4236/asm.2013.31003 Published Online January 2013 wrote:http://file.scirp.org/pdf/ASM_2013012514045982.pdf

Pseudo-capsule “coffin effect”: How to prevent penile retraction after implant of three-piece inflatable prosthesis Enrico Caraceni, Lilia Utizi, Giovanni Angelozzi; Department of Urology, Civitanova Marche Hospital, Italy.
Read summary
https://www.ncbi.nlm.nih.gov/pubmed/25017596
Download full article
http://search.myway.com/search/GGmain.j ... 0097389852

Both Dr. Eid AND Dr Karpman told me to not bother with Vaccum Erection Device -- I asked them point blank 6 weeks before surgery. There was no hesitation from either of them, and they gae an emphatic "no".

Note, I have a "normal dick." So there was no post prostatectomy shortening to contend with, and quad mix injection induced erection had been working as recent as seven months before surgery. Also, no Peryoines disease.

TANGERINE wrote:Both Dr. Eid AND Dr Karpman told me to not bother with Vaccum Erection Device -- I asked them point blank 6 weeks before surgery. There was no hesitation from either of them, and they gae an emphatic "no".

Note, I have a "normal dick." So there was no post prostatectomy shortening to contend with, and quad mix injection induced erection had been working as recent as seven months before surgery. Also, no Peryoines disease.

Tangerine, exactly right. I infer from what all three of these Doctors (Eid, Karpman and Kramer) have said, some (maybe most) men will see no (size) benefit from pre-op vacuum protocols and they do not deny that some men might see benefit.

From anecdotal testimonies (including mine) there may be benefit. Whether that benefit is permanent or substantial enough to be worth the trouble is open to question, though. But I have seen research published in respectable medical journals that indicate there is valid benefit there.

Two other conclusions the Sellers-Dineen paper indicated are 1) that insertion of the implant during surgery is easier for the surgeon to accomplish and 2) that post-op recovery is easier and quicker for the patient.

While the authors of the paper state that those conclusions need more investigation, the fact that these are mentioned carries weight with me. Anything that makes my recovery easier and quicker, I am all for; and there does not seem to be a downside to VED therapy pre-op except for the time involved and the price of the device.

This is all good to know. I haven't had my surgery yet but my Uro advised against a VED.

This said Rugby Dave says after his prosectomy that the VED helped gain back some of his lost length. Maybe in some cases it can help but it's not something I'm considering personally.

Dr. Kramer told me it may make no difference but to go ahead as its would not hurt. I did continue to pump right up to two days before surgery and I think it helped in My size has come back nicely within about .25" of old length. Would like what i had at 20 but a lot of years of nothing due to ED and no use.

Pump and enjoy t sight as this is what is coming.

I guess it depends on who you ask ... a URO who specializes in ED rehab, or a surgeon who specializes in Implants ...

For me I lost several inches after robotic prostrate surgery ... my (local) URO had me start VED prior to surgery ... I was able to regain all that I had lost with daily VED use ...

Is the daily use of vacuum erection device for a month before penile prosthesis implantation beneficial?
https://www.ncbi.nlm.nih.gov/pubmed/27654466

Evaluating the efficacy of vacuum constrictive device
https://www.ncbi.nlm.nih.gov/pubmed/24469653

Yeah, like asking 6 weeks before the surgery when this needs to be done consistently for a long time.. Like 1+year, maybe along with traction. What do you think they would say?

As a patient of Dr. Dineen, I had the opportunity to speak with both him and Tom Sellers regarding the benefit of using a VED prior to surgery. I was concerned with loss of length, as most of us are when facing implant surgery. He was very reassuring saying that since they instituted the VED protocol, they have virtually eliminated complaints of size loss in their practice, as well as being able to insert larger implants than the reported 'average'. Not being 'well hung', it was a major concern for me, and I liked the information he and Sellers gave me. After my implant, my length was the same as it was prior to ED. So, for me, I believe there was a benefit to using the VED. That being said, I may have been lucky and not lost size without the VED, but since I will never know for sure, I'm glad I at least gave myself every opportunity for a satisfactory outcome.

Thanks for your feedback! I just got my referral to Dr. Brock. I'm going to get my appointment date within the next few days. i'm looking forward to it.