ED: A guide to pumps, implants and surgery

Introduction

Oral tablets for ED, such as Viagra, have become conventional over the past 20 years. When these are not suitable, alternative treatments like injections, creams, and urethral suppositories may be considered. In rare cases where medications are ineffective, options such as devices and surgery might be explored.

Vacuum Constriction Pumps (VCPs):

These devices, existing since 1985, have gained popularity in the twentieth century, partly due to discreet online access. Some sources claim benefits for both erectile dysfunction and penile enlargement, although evidence supporting the latter is limited. While not proven to increase size, constriction pumps can be beneficial in treating ED, with one study indicating a 70% success rate.

To operate a VCP, a plastic cylinder is placed over the penis, creating a vacuum that draws blood, encouraging an erection. A hand or battery-operated device is used, and a ring or band is placed at the base of the penis to maintain rigidity. Caution is advised, limiting the band to 30 minutes, as per the British Association of Urological Surgeons (BAUS).

Despite the potential effectiveness, VCPs are less popular than oral treatments, likely due to the ease of administration, discretion, and longer-lasting effects of oral medications, which are also more cost-effective.

According to BAUS, VCPs are available for purchase, with prices ranging from £120 to £350. Specific NHS coverage is limited to patients meeting certain criteria related to health conditions or treatment history.

Getting a Vacuum Pump:

Before purchasing, a consultation with a doctor is advisable. They can provide tailored advice, helping individuals weigh the pros and cons based on their health and circumstances.

Who Can Use Vacuum Pumps:

VCPs differ from conventional treatments, allowing use in men with certain pre-existing conditions. However, if individuals take blood-thinning medications or have sickle-cell anemia, VCPs may not be suitable and may not be recommended by health professionals.

Side Effects of Vacuum Pumps:

Because VCPs are for external use, side effects are limited. Correct use, demonstrated by a doctor or urologist, can reduce the chances of side effects. Possible side effects include red/purple dots on the skin, numbness or coldness during band use, mild pain or bruising (usually due to incorrect use), and potential discomfort during ejaculation if the band is too tight.

Buying a Vacuum Pump:

If purchasing a VCP over-the-counter, consider the following:

  1. Ensure a limit on vacuum pressure to prevent damage.
  2. Verify that the constriction band applies gentle pressure without discomfort.
  3. Choose a device specifically designed to treat erectile dysfunction, avoiding those claiming enlargement without safety considerations.
Vacuum Constriction Pumps (VCP) AdvantagesVacuum Constriction Pumps (VCP) Disadvantages
Worthwhile – Because pumps can be effective, they can be a long-lasting solution to your erectile dysfunction. You won’t need to spend money on expensive treatments.Time constraints – For safety reasons, the constriction ring or band must be removed after 30 minutes to avoid any circulatory damage. 
Lasting – The ring, or constriction band, helps to maintain fitness and prevents blood from traveling away from the penis. Success rate – While VCPs can be effective, they’re not guaranteed to work for everybody. 
Effective – Once you have the hang of using them, pumps can be highly effective.Side effects – While there aren’t many if used correctly, VCPs can cause some side effects like swelling or bruising.
Non-Prescription – Most men can use a VCP given they can afford it. No prescription is required. Expensive – Costs tend to vary between £120 and £350. This might not be a viable option for everyone.
External – VCPs are for external use. This means any side effects are limited, and are likely to be visible and easily diagnosed. Preparation – VCPs aren’t the most useful for spontaneous sexual activity. They require some preparation time before sex.
Pre-existing conditions – Many men who would not be able to take PDE5is (like Viagra) can use VCPs. Enlargement – Despite what some online sources may claim, VCPs do not increase the size of your penis over time. 
Side effects – VCPs typically don’t cause many side effects when used correctly.Unnatural – The nature of VCPs can make erections feel odd, awkward or unnatural. 

Vascular Reconstruction Surgery:

When conventional treatments for erectile dysfunction (ED) fall short, vascular reconstruction surgery emerges as a potential alternative. Notably, vascular surgery evolved into a distinct surgical specialty in 2012, separating from its status as a subspecialty of general surgery, with the first trainee vascular surgeons commencing training in 2013.

Vascular reconstruction surgery involves intricate procedures concerning veins, arteries, and the vascular system. In the context of ED, the surgery aims to achieve one or both of the following objectives:

  1. Reconstruct or Re-route Arteries: This involves bypassing blocked or tightly-restricted vessels in or near the penis.
  2. Unblock Vessels: The procedure addresses vessels that hinder proper blood flow in and out of the penis.

Despite its potential benefits, vascular reconstruction surgery is marked by its high cost, technical complexity, and variable success rates. Consequently, doctors are cautious in recommending it as a treatment for ED.

Eligibility for Vascular Reconstruction Surgery:

Recommendations for vascular surgery, even unrelated to ED, are generally made when deemed necessary. Various health conditions affecting the vascular system can often be managed through medications and lifestyle adjustments. However, when it comes to ED, the National Health Service (NHS) in the UK does not cover the costs of vascular reconstruction surgery. Therefore, individuals considering this option must typically pursue it through private means, incurring substantial expenses.

Men more likely to be recommended for vascular reconstruction surgery are usually younger, around 45 or below, and have experienced physical trauma in or around the groin, leading to the development of ED.

Side Effects and Risks:

Like any intricate surgical procedure, vascular reconstruction surgery carries inherent risks and potential side effects:

  1. Common Side Effects: These include bleeding, bruising, or swelling at the surgery site, along with a risk of infection during the initial healing phase.
  2. Visible Scar Tissue: After complete healing, the surgical site may exhibit permanent, visible scar tissue. In severe cases, this may result in a distorted shape and painful erections, possibly accompanied by a lasting sensation of numbness.
  3. Technical Risks: Given the procedure’s technical complexity, there is always a risk of error, and success is not guaranteed.
  4. Diminishing Effects Over Time: Some individuals may experience a diminishing impact over time, with symptoms of ED potentially resurfacing after an initially positive outcome.
Advantages of Vascular Reconstruction Surgery (VRS)Disadvantages of Vascular Reconstruction Surgery (VRS)
Natural – Unlike other methods, VRS can restore the ability to achieve a natural erection.Expensive – VRS often has to be paid for privately and is highly costly. 
Route of the Problem – If ED is caused by a problem with the blood vessels, VRS can tackle the route of this problem. Risk – There are a number of risks associated, including that VRS doesn’t always work and can cause lasting physical changes in appearance. 
Psychology – ED can have a negative psychological impact. VRS can help men to have normal sex lives, which can improve their quality of life. Invasive – Highly technical procedure and can be quite invasive. 
Age – The younger you are, the more likely VRS is to work.Time – Symptoms of ED can return after some time. 
 Recommendation – Often, doctors will not recommend VRS for ED. 
 Failure – VRS for ED has a low success rate. 

Surgical Implants for Erectile Dysfunction

For individuals who have exhausted various treatment methods for erectile dysfunction (ED), including lifestyle changes, therapy, prescription treatments, or vacuum constriction pumps, surgical implants may be a recommended solution. Surgical implants involve the insertion of a prosthetic implant, or prosthesis, to enable men with ED symptoms to achieve an erection.

Types of Surgical Implants:

There are three primary types of penile surgical implants, and the choice among them typically involves consultation with a doctor or surgeon.

  1. ‘Malleable’ Rods:
  • This option entails the insertion of two flexible metal rods into the penile shaft, inducing a state of lasting, partial rigidity.
  • The rods can be reshaped or straightened when an erection is desired for sexual activity.
  • While effective during sexual encounters, the constant state of rigidity may pose challenges in certain situations, such as swimming or playing sports. It can also be generally uncomfortable outside of intimate moments.
  1. ‘Inflatable’ Rods:
  • This more widely sought-after option avoids a lasting state of firmness.
  • Inflatable rods typically consist of three components:
    • Two inflatable tubes or rods are placed inside the penis.
    • An inflatable pump situated inside the scrotum.
    • A fluid-filled reservoir or container (either in the scrotum or abdomen), connected by intricate tubing.
    • Applying pressure to the inflatable pump prompts fluid movement from the container into the rods, causing inflation and mimicking the appearance of growth and an erection.
    • Post-intercourse, a small valve is pressed to return the fluid to the reservoir, causing the penis to become flaccid again.
    • This method closely mirrors the natural erection process, with the rods acting like smooth muscle or corpus cavernosum, and the fluid simulating blood.
    • Some individuals find that inflatable rods closely resemble natural erections, resulting in overall high satisfaction. However, some report that the induced ‘erection’ may not last as long as a natural one, an aspect surgeons are actively addressing.

Selecting the appropriate surgical implant is a personalized decision, emphasizing the importance of discussions with medical professionals to determine the most suitable option based on individual needs and preferences.

 Advantages of Surgical implantsDisadvantages of Surgical implants
Natural – Some men report the surgical implants feel just as a normal erection would. Expensive – Often an expensive procedure which will have to be sought out privately.
 Invasive – The procedure is typically quite invasive. General anesthesia is sometimes used. 
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