Vacuum pump. The Vacuum pump ( VP) is a device of utmost importance for penile rehabilitation and for people partially or totally impotent non responder to drug intake or unwilling to take those pro-erection drugs in a continuous or planned way.
In diabetics patients non responder to 5α-reductase inhibitors, the use of VP coupled with the constrictor ring wearing is the only procedure able to get a satisfying erection for intercourse.
The Air-VP are devices employing air to get vacuum by withdrawing atmospheric air from a cylindrical container applied onto the penis. In more recent times have been proposed some devices utilizing water instead of air, Water-VP. In this case is the water the medium able to exert
the suction on the penis completely swamped into some warm water.
Must be pointed out moreover that the VP use implies an accurate pubis depilation made preferably by hair removal cream because the use of razor can produce micro-lesions possible gateway for pathogenic agents. This depilation should be repeated periodically at least twice a month. More in general, depilation should be performed whenever some devices are applied onto the penis, above all in case of VP or Long Lasting Rings (LLR). The use of VP requires a prolonged learning time because is mandatory to know how to protect the gonads from the suction and to learn times and ways of aspiration.
For erectile rehabilitation the VP is used to do penis vascular structures some passive working out consisting of arterial blood withdrawing into corpora cavernosa and leaving it rush down through veins so restoring normal pressure levels. In this way are recreated same conditions as in physiologic erection with beneficial effects on erectile function. But above all this vascular gym is useful when the penis is suffering from some chronic vascular deficiency as in diabetic or atherosclerotic disease with following penile retraction and fibrosis more or less extended. In those cases the VP use represents the best rehabilitation method to regain trophysm and elasticity of tissues. Another field of VP application is the rehabilitation after total prostate surgical ablation for cancer.
In those conditions, as direct consequence of surgery, the urethra is shortened with following penis shrinkage. Moreover, always as consequence of surgery, can take place some more or less pronounced and lasting erectile deficiency. The rehabilitation therapy by VP associated with pro-erection drugs assumption can promote a faster and better erectile regain. Main difficulty in VP usage refers to the fact that the pump must be adapted to anatomical features and sensitivity of patient. VP must be used with a series of accessories to help pubis skin adhere as well as possible to pump cylinder providing so an optimal tightness and avoiding suction of some pubic or scrotal skin portions with following pain, possible damage of testes and mandatory interruption of procedure. To this aim, to avoid the testes should be withdrawn into the cylinder, is helpful to block them into the scrotum by an appropriate elastic ring. For the same reason, to facilitate best adaptation of VP cylinder to the pubis, most appropriate seal must be chosen with regard to shape and material softness.
The aspiration must be applied with extreme prudence, with step by step vacuum pumping to allow penis for adapting slowly and gradually to absence of pressure. If some abnormal suctions of pubis or scrotum skin portions take place , the procedure must be stopped and started again. After first aspiration has been exerted for few seconds, without abnormal suctions, the procedure must be stopped and restarted after some seconds always with short phases of aspiration. The patient will begin to feel some constriction at the penis base, tolerable constriction that slowly turns into a feeling of stretching all along the penis cylinder and at the end into the glans. When the patient will feel best expansion strength into the glans, his penis has reached best possible erection with limit expansion of all penis elements, above all the corpora cavernosa, far greater then physiologic erection.
This procedure can be repeated many times in case of rehabilitation session. If, on the contrary, the procedure is done for sexual purposes, at the end of suction a constriction ring previously assembled to the cylinder must be released at the penis base to hold the penis well erected as long as necessary for a sexual intercourse. In USA the VP usage is the most adopted procedure from diabetic non-responder patients and much advised from American Diabetes Association (ADA). Furthermore to potentiate the erection strength and promote the erectile restoration is really useful to exert onto the penis, previously erected by VP and held erected by constriction ring, some positive pressure by compressive cuff able to exert pressures at controlled levels of mmHg. The pressure check is made by appropriate manometers inserted into the inflation line to prevent pressure from exceeding 200 mmHg.
The VP alone isn’t able to increase penis dimensions but if on maximally erected penis as after VP is released a soft rings according to LLR concept, is held longtime a turgidity condition really useful to promote penis augmentation.
Results. The VP is a tool of proven efficacy to get erection in non-responder diabetic patients.
In the same way VP is useful in penis rehabilitation after total prostate surgical ablation also to regain length reduced by the surgery.
VP is also much helpful for penis augmentation if associated with LLR procedure.