Archive for May, 2014

Erectile Dysfunction. Penile Rehabilitation

Almost anyone with ED is qualified for VCD therapy. Its indication ranges from ED to postprostatectomy penile rehabilitation and even penile length preservation. Its application is constantly being expanded to new horizons in keeping up with the technological evolution.

Erectile Dysfunction and Discount Viagra Australia

There are hardly any contraindications for the use of VCD therapy in patients with ED. Before the 5-phosphodiesterase inhibitors (5-PDEi) era, VCD was among the first-line therapies for ED regardless of etiology. In patients who cannot tolerate 5-PDEi side effects, or in whom these medications are contraindicated, VCD becomes an optimal treatment option. It has also been recommended for elderly patients who have sporadic sexual intimacy, as younger patients may have perception of an unnatural erection. On the other hand, Chen et al. demonstrated that VCD remained a preferred treatment option in a certain subset of patients who achieved satisfactory erections with both VCD and oral 5-PDEi. However, those patients who had used both oral 5-PDEi and VCD simultaneously reported higher sexual satisfaction and penile rigidity.

Penile Rehabilitation

Penile rehabilitation refers to the therapeutic measures focused on the prevention of damage to cavernous tissue after radical prostatectomy (RP) by providing adequate oxygenation to the cavernous tissues. The main purpose is to prevent structural alterations within the corpus cavernosal smooth muscle, maximizing the chance to recover functional erections in a man who has undergone RP and is hoping to regain his preoperative level of erectile function. Penile rehabilitation objectives include the protection and/or regeneration of the following elements from the corpora cavernosa: cavernous nerves, corporal smooth muscle, and corporal endothelium. This should be started as early as two weeks post-op, as venous leak, suggestive of corporal smooth muscle fibrosis, may develop. VCD has an important role in penile rehabilitation by producing an artificial erection and inducing blood flow to the penis, thereby “oxygenating” the corpora cavernosa. It is recommended that VCD therapy is started as early as possible after RP, either alone or in combination with oral medications.

Penile Length Preservation

Penile shortening after RP is a common phenomenon. In fact, more than 60% of those patients experience penile shortening with varying degrees, ranging from 0.5 to 5 cm. Several investigators have looked into using VCD after RP to preserve penile length and girth. Dalkin et al. reported only a 3% rate of stretched penile length reduction of 1 cm or more in compliant patients. In his study, both pre- and postoperative stretched flaccid penis length were measured. After the Foley catheter was removed, these patients were asked to use VCD on a regular basis. Among those who were at least 50% compliant, 35/36 (97%) maintained their preoperative stretched penile length. Other authors had come up with equally convincing evidence as well. As more data emerges, it is becoming normal to use VCD therapy postprostatectomy to maintain penile length, as well as to regain preoperative erectile function.


There are a few contraindications to VCD therapy. These include bleeding disorders, anatomical deformation of the penis, and unexplained priapism. Those patients on anticoagulation are more prone to develop bruising or hematoma formation, whereas patients with blood dyscrasias are at increased risk of developing priapism. Relative contraindications include cultural issues that consider it taboo to obtain an artificial erection with the aid of external devices, and patients with cervical or high-thoracic spinal cord injuries, neurological, or degenerative joint diseases with poor manual dexterity, unless their sexual partners are willing to be involved in the process.


Prostate cancer is the leading cancer in men. According to the National Cancer Institute, there are more than 189,000 new cases of prostate cancer diagnosed each year. Despite the fact that the incidence and mortality rate from prostate cancer are declining, more and more patients are taking an active role in their health. Parallel to the rate of treatment is the incidence of ED. It is estimated that the incidence of ED after RP ranges between 40 and 85%. Even after the introduction of nerve sparing technique, the potency rates vary, depending on individual surgeon’s experience and technique, as well as patient’s age, comorbidities, and preoperative sexual function. This new trend has led to the novel application of VCD therapy, including penile rehabilitation following RP.