Injustright wrote:Yes. I can read scientific articles, including the portion of the article that references VED use pre-surgery. The particular publication you mention says next to nothing about post surgical use of VEDs. The Sellars et al study cited in the article referred to the benefit of VED use prior to surgery for allowing the maximization of implant size. It wasn’t focused on post implant rehabilitation.
Just use a fucking VED before and after. It's good for both. Let me spell it out for you more.
The whole summary of the Canguven study is worth a read:
Patient concerns about penile length after penile prosthesis (PP) implantation for erectile dysfunction (ED) have significant impact on patients and their partners. In addition, corporal fibrosis is associated with difficult PP implantation. The preoperative use of vacuum erectile devices (VED) is an uncommon physical treatment for such concerns. Therefore, the current randomized controlled study assessed two outcomes: whether pre-operative VED use for a month before surgery would significantly increase flaccid stretched penile length (SPL) on the day of surgery, and facilitate easier corporal dilatation intraoperatively. Fifty-one patients scheduled for PP implantation for ED were randomized to either intervention group (pre-operative VED use; 10–15 min/day for ≥30 days; Group A; n = 25), or control group (no intervention; Group B; n = 26). A research assistant (blinded to the treatment assignments) recorded SPL at baseline (initial consultation) and on day of surgery. The surgeons performing the PP implantation (also blinded to the treatment assignments) provided subjective assessments of the ease of corporal dilatation. Baseline patient characteristics, demographics, and comorbidities were the same in both groups. Baseline measurements (SPL-1) were 10.71 1.28 and 10.87 1.26 cm in Group A and Group B, respectively; and the day of surgery measurements (SPL-2) were 11.50 1.33 and 11.06 1.34 cm in Group A and Group B, respectively. In terms of outcomes: mean SPL increase in Group A was significantly more by a mean of 0.80 0.38 cm (p < 0.05) compared to Group B; and surgeons’ subjective report of surgical ease indicated smoother corporal dilatation for Group A compared to Group B. VED use (10–15 min/day during the month prior to PP implantation) was associated with significantly increased SPL on day of surgery, and facilitated easier corporal dilatation intraoperatively. Future studies should examine the long-term outcomes of penile prosthesis implantation after pre-operative use of vacuum erectile devices.
For specifics:
When pre-operative VED is used, SPL [flaccid stretched penile length] could increase by a mean of 0.80 +- 0.38 cm. In addition, the surgeon is provided with better opportunity to restore longer penile length that replicates an appearance more consistent with the patient’s natural erection. Ease of corporal dilation allows for an appropriate size cylinder to be inserted, and thus helps to maximize patient satisfaction post-operatively. There were no negative intraoperative complications associated with the use of pre-operative VED, and therefore, if patients have access to it, VEDs can safely be recommended. Future studies among larger samples will help assess the long-term outcomes and outline the role of VED as a valuable intervention prior to PP implantation.
Canguven, O., Talib, R. A., Campbell, J., De Young, L., El Ansari, W., & Al-Ansari, A. (2017). Is the daily use of vacuum erection device for a month before penile prosthesis implantation beneficial? A randomized controlled trial.
Andrology, 5(1), 103–106.
https://doi.org/10.1111/andr.12258THIS IS ABOUT USING A VED AFTER SURGERY. The fact that it's about the AMS doesn't mean anything.
Penile shortening after inflatable penile prosthesis placement for erectile dysfunction is a common postoperative patient complaint and can reduce overall satisfaction with the procedure. In this prospective study we report our results regarding penile dimensions and patient satisfaction outcomes after 1 year of follow-up from AMSTMLGX700® penile prosthesis implant with 6 months of vacuum erectile device therapy. Seventy-four selected patients with medically refractory erectile dysfunction underwent AMSTM LGX 700® IPP placement. Postoperatively, patients were assigned vacuum device therapy for 5 min twice daily. Follow-up continued for 1 year after surgery. Dimensional and functional results were assessed. Baseline median preoperative stretched penile length and girth were 14 cm (range 10-17) and 9 cm (range 7-12), respectively. At the end of the study penile median dimensional outcomes were 17 cm (range 13-23) for length and 11 cm (range 10-13) for girth while a median number of 24 pumps (range 18–29) to fully inflate the device was seen. Baseline median International Index of Erectile Function (IIEF-5) score was 9 (range 5-11), at 6 months 20 (range 18-26) and at 1 year was 25 (range 20-27) (p<0.0001). Median Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) score at the end of the follow-up was 74 (range 66–78). Our postoperative rehabilitation program is feasible and should be recommended after prothesis surgery in order to increase overall satisfaction with the procedure. Penile postoperative dimensional outcomes were statistically significant improved and complications were negligible.
Antonini, G., De Berardinis, E., Busetto, G. M., Del Giudice, F., Chung, B. I., Conti, S. L., Ferro, M., Musi, G., Fragas, R., De Cobelli, O., Sperduti, I., Gross, M. S., & Perito, P. E. (2020). Postoperative vacuum therapy following AMSTM LGX 700® inflatable penile prosthesis placement: Penile dimension outcomes and overall satisfaction.
International Journal of Impotence Research, 32(1), 133–139.
https://doi.org/10.1038/s41443-019-0125-z\
The results of our study suggest that the AMS 700 LGX IPP could be used to prevent penile
shortening in patients undergoing IPP implantation. Furthermore, erectile function and patient satisfaction were improved excellently. The mean stretched flaccid penile length was 11.1 ± 0.8 cm at baseline and was longer at 3 months (11.9 ± 0.9 cm, P < 0.001), 6 months (12.0 ± 0.9 cm, P < 0.001) and 12months (12.2 ± 0.7 cm, P < 0.001) postoperatively. There was no significant difference in the stretched flaccid penile length between 6 and 12 months (P = 0.31). The mean and penile length with the IPP fully inflated was 11.8 ± 1.2 at baseline, 12.6 ± 1.0 at 3 months, 12.6 ± 1.1 at 6months, and 12.7 ± 1.2 at 12 months. There was a statistically significant difference in penile length with the IPP fully inflated from baseline to 3, 6, and 12 months (P < 0.001). No statistical difference in penile length with the IPP fully inflated was noted between 6 and 12months (P = 0.14) (Table 2).
Kim, K. S., Bae, W. J., Kim, S. W., & Lee, M. Y. (2019). Experience with AMS 700 LGX penile prostheses for preserving penile length in Korea. BMC Urology, 19(1), 6.
https://doi.org/10.1186/s12894-018-0425-5PI surgery does not decrease penile size compared to the preoperative stretched measure but preserves or increases it for the great majority of patients. Men having an IPP are likely to witness a more substantial length increase than those with a MPP. The outcome of PI surgery was not affected by co-morbidities such as diabetes, HTN or PD. Preoperative penile length and girth correlate well with the immediate postoperative erect penis. Recording penile dimensions in the clinic and agreeing these with patients’ preoperatively may be a way of improving satisfaction levels with penile size postoperatively. It is interesting to speculate whether some men who are concerned about penile size preoperatively would be better managed by either psychosexual counselling or if the IPP may give greater satisfaction. In any event, patients can be reassured that no immediate direct size loss is expected in the great majority of cases.
Habous, M., Giona, S., Tealab, A., Aziz, M., Sherif, H., Abdelwahab, O., Binsaleh, S., Ralph, D., Bettocchi, C., Mulhall, J. P., & Muir, G. (2019). Penile length is preserved after implant surgery.
BJU International, 123(5), 885–890.
https://doi.org/10.1111/bju.14604Loss of erectile length is common following radical prostatectomy and in select cases following placement of an inflatable penile prosthesis (IPP). In an effort to maintain penile length and minimize shortening, and offer a degree of length recovery, cylinders with controlled length expansion have been developed (LGX cylinders, American Medical Systems, Minnetonka, MN). It has been theorized that, over time, repeated inflation of these cylinders will cause stretching of the corporal bodies and promote increased erectile length. We report prospective length data from a series of men implanted with LGX cylinders.
Methods: Twenty patients underwent implantation of a 3-piece inflatable penile prosthesis, utilizing LGX cylinders. Penile length, as measured from pubic bone to tip of the glans penis with the prosthesis maximally inflated, was assessed at 2 weeks post-surgery as a baseline, and then at 6, 12, and 18 months post-surgery. Patients were instructed to begin daily inflation of the prosthesis for 1 hr starting at 2 wks postsurgery and continuing until 3 mths after surgery. At that point, the regimen was modified to 15 minutes per day a minimum of 4 days per week.
Results: Median follow-up was 11 mths (6–18 mths); all length changes are reported as median values (range). At 6 mths post-IPP, length gain from baseline was 9 mm (5–20 mm). At 12 and 18 mths respectively, increases of 20 mm (5–35 mm), and 30 mm (10–45 mm) were noted. Interval changes between 6 and 12 mths were 11.5 mm (0–25 mm) and a further 9 mm (0–25 mm) from 12–18 mths. There were no instances of length loss noted from baseline values in this series.
Conclusion: A dedicated post-operative inflation protocol promotes increased measured erectile length in men implanted with controlled length expansion (LGX) cylinders.
Christine, B, MD; Bella, A, MD. Controlled Length Expansion Cylinders: A Defined Post-Operative Inflation Protocol Yields Measurable Length Gain.
Southeastern Section of the American Urological Association, Inc. (SESAUA).
METHODS: 750 Patients are instructed to use a vacuum erection device for 10 minutes each day for up to 2 months prior to IPP implant. After two months, maximization of cylinder length is accomplished regardless of IPP manufacturer. Cylinders are left partially inflated in the postoperative period and daily inflation for 3 months immediately upon patient tolerance. The average implanted cylinder length has increased dramatically with the preoperative vacuum usage when compared to the authors’ previous implantations and when compared to the national average of implanted cylinders obtained from one manufacturer.
RESULTS: Preoperative use of the vacuum device has allowed maximization of cylinder length. After the vacuum program, patients tend to experience less pain following implantation allowing earlier device instruction cycling and use. The average implanted cylinder length continued to increase annually for the first 5 years as the protocol evolved and seems to have remained stable for the last five years.
CONCLUSIONS: Preoperative vacuum usage and postoperative capsule management has nearly eliminated patient complaints of reduced penile length. We believe this to be the result of larger size cylinders being implanted when compared to our previous implantations absent of the patient participation protocol.
Sellers, T., Dineen, M., Salem, E. A., & Wilson, S. K. (2013). Vacuum Preparation, Optimization of Cylinder Length and Postoperative Daily Inflation Reduces Complaints of Shortened Penile Length Following Implantation of Inflatable Penile Prosthesis.
Advances in Sexual Medicine, 3(1), 14–18.
https://doi.org/10.4236/asm.2013.31003 Eighteen patients were included in the penile measurement substudy. Both the flaccid and stretched penile measurements showed an increase from preoperative to postoperative. The flaccid penis measurements increased 2.43 cm (range 1.4– 3.2 cm), from 8.57 cm preoperatively to 11 cm postoperatively. After IPP implantation, the erect measurement increased 1.73 cm (1.1–2.2 cm), from 10.71 cm to 12.44 cm, after suspensory ligament incision. No substudy patients had a shorter penis preoperative to postoperative…
As demonstrated in this cohort of patients, insertion of a penile implant with concomitant incision of the suspensory ligament minimizes the risk of phallus shortening with excellent satisfaction of the patient. This is in contrast to some studies going up to 30% with patients complaining of shortening of the penis [9,16].
Borges, F., Hakim, L., & Kline, C. (2006). ORIGINAL RESEARCH—SURGERY: Surgical Technique to Maintain Penile Length After Insertion of an Inflatable Penile Prosthesis via Infrapubic Approach.
The Journal of Sexual Medicine, 3(3), 550–553.
https://doi.org/10.1111/j.1743-6109.2006.00232.x9 and 16 refer to Montorsi et al., European Urology, 2000 and Montorsi et al.
International Journal of Impotence Research, 1996 – so, well, those studies are two decades old.
The patients were encouraged to use the traction device for a minimum of 3 hours per day for 2–4 months. Following the traction period, SPL was measured, and this was compared with inflated penile prosthesis erect penile length, measured from the same points from the pubis to the corona dorsally. In doing our measurements this way, we felt that we would have two reliable and repeatable points for measurement.
Although not all men gained length following prosthesis placement compared with their pretraction length, none of these patients lost length, and 70% gained length of up to 1.5 cm.
….It does appear from this small prospective, but noncontrolled study, that men with penile shortening before penile prosthesis surgery may prevent further length loss or possibly gain some additional length as a result of short-term preoperative ETT. The protocol was safe and well tolerated, as there were no local complications and no change in penile sensation. But the protocol is a tedious one, and to be effective, it requires a serious commitment from the patient. Clearly, larger scale studies will be necessary, possibly with a non-traction control arm. This approach could also be considered for men who do not have significant penile scarring, where the potential for gaining even more length may be possible prior to penile prosthesis implantation.
Levine, L. A., & Rybak, J. (2011). Traction Therapy for Men with Shortened Penis Prior to Penile Prosthesis Implantation: A Pilot Study.
The Journal of Sexual Medicine, 8(7), 2112–2117.
https://doi.org/10.1111/j.1743-6109.2011.02285.xIn our study, the stretched penile length was at least 1 cm longer at 12 months than preoperative and 6 months measurements in all patients, confirming the elastic properties of the penis, irrespective of the normality or abnormality of the corpora cavernosa…. Overall our study shows that the AMS 700 LGX provides a reliable solution to short penis syndrome post‑IPP implantation, providing a penile length comparable to the natural erection. The AMS 700 LGX is a powerful tool to preserve penile length in patients undergoing penile prosthesis implantation as demonstrated by the high satisfaction rate, with 80% of patients satisfied with their final penile length. Therefore, the AMS 700 LGX should be considered in all patients (except those with penile fibrosis or scarring) in order to preserve penile length, allowing time for mechanical, behavioral and psychosexual adaptation.
Augusto Negro, C. L., Paradiso, M., Rocca, A., & Bardari, F. (2016). Implantation of AMS 700 LGX penile prosthesis preserves penile length without the need for penile lengthening procedures.
Asian Journal of Andrology, 18(1), 114–117.
https://doi.org/10.4103/1008-682X.154311The Figures are worth looking at in the Augusto study.
Do you need any more proof???? Maybe I can get a doctor or researcher to write it out in plain text for the people of FrankTalk to understand: "hey old dudes, use a VED before AND after surgery because they're good for your dick!! You know how your weak and mostly impotent dick is like now?? Wellllll, a VED makes it bigger and better!!!!!!!!!!"
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