Is it time for a pump

I posted some information on your other thread. I don't think a pump is the next thing you should try.

But if you do decide to buy one come back for suggestions so you don't pay too much.

You should have been using the vacuum device soon after your surgery.

I think even the studies on this are a bit mixed. You might just want to invest in one and do the experiment yourself.

PDA-

Why do you say that? What I've read is that pump should start after the catheter is out.

"Daily use of a vacuum erection device (VED) was begun the day after catheter removal"
Preservation of penile length after radical prostatectomy: early intervention with a vacuum erection device

"Initiating the use of a VED protocol at 1 month after RP improves early sexual function and helps to preserve penile length."
A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy

Are there studies that suggest the contrary?

Tall,

I wasn't so much trying to talk him out of getting a pump as suggesting he look into injections first. But, I didn't say that at all clearly -- or, at all on this thread, come to think of it. On his other thread I posted two videos, one by Dr Mulhall and one by Dr Gillman in Audtralia. Both of them think that if men don't respond fairly quickly to PDE5i drugs they should move on to injections to ensure the prompt oxygenation of the erectile tissues to prevent atrophy (scarification, fibrosis, etc.). They are both ambivalent about VEDs with Gillman stating that they do a so-so job of oxygenating the tissues. I have seen a few more-recent studies about oxygenation with a VED (used w/o constricting bands) that seem to show better levels than I have seen in older studies but they still don't get the same levels as one sees with injections. The studies you linked show a benefit from a pump, granted, but there are studies with injections that show similar or better results.

So, to (finally) be clear, I think that it is time for raypaul to talk to his doctor about injections since he hasn't responded to PDE5i drugs and he needs to find a way to get several erections a week to prevent atrophy. He can also get himself a pump which will probably help with maintaining size and may, or may not, help much with oxygenation. I'm not down on pumps. I think they are a great adjunct to pills or injections, whichever works. I used my pump four days a week for years. (The other three days I injected.) I wound up getting an implant because neither the pump nor the trimix could overcome my venous leak but I am convinced that the combination of pumping and injecting helped me get a bigger implant than I could have accommodated if I had let Mr. Unreliable shrivel.

Tall,

Here's an article I looked at while I was trying to find some more-recent info on the antihypoxic benefits of the use of a VED. It illustrates the all-over-the-map-edness of the data on penile oxygenation with pumping:

Vacuum therapy in penile rehabilitation after radical prostatectomy: review of hemodynamic and antihypoxic evidence.

I would be tempted to characterize the results for pumping follows:

-- Pumping with a constricting band is useable for sex and may help preserve size but it is of little or no benefit for tissue oxygenation.

-- Pumping without a band may be of some help with oxygenation but it is useless for having sex.

The last paragraph in their discussion is also interesting. In it they worry that while the use of a VED may improve oxygenation of the distal penis -- which is easy to see and to access for blood chemistry measurment -- the base of the penis may be worse off since it doesn't get any extra blood flow but it does participate in the backflow of venous blood.

These aren't awful problems -- not reasons to forego pumping -- but they do hint at shortcomings that pills and injections don't have. Which is why I think a man should alternate pills or injections (whichever works) along with the use of a VED.

As for concerns about injections causing scarring which causes Peyronie's plaques to form I tend to think the issue is at worst a wash. It's possible that injecting can cause scarification, especially if the man fails to apply pressure at the site as directed, but so does hypoxia cause scarring and fibrosis. Injections, properly done, probably reduce the risk of Peyronie's which is high for men after prostate surgery whether they inject or not. Men who inject and subsequently develop Peyronie's will fequently believe there is a causal relationship but I have never seen any numbers that show one.

I have always used a pump regularly (now for 8+ years) starting from a month out from RALP surgery. I did eventually start up injections but probably too late to help with any recovery if that was possible.

However, there is a very easy and painless way to get some good increased bloodflow after RALP by simply using a small amount of Alprostadil (say, 300 mcg) in a ml of water solution and splooshed in urethrally (ideally every night). This would become absorbed into the corposa and really get good blood flow thru the whole penile system almost the same as an injection (but probably not enough for actual intercourse -- but this would really be for penile rehab/regen anyways).

Unfortunately the only way to acquire that much Alprostadil would be to purchase MUSE 1000 mcg pellets thru prescription ( best price might be 6 pellets for $100 if you have decent drug coverage.) That could make 18 splooshes at 300 mcg or 24 splooshes at 250mcg.

The advantage of this method is it is painless (and NO you do not get the burning sensations like you do from a MUSE pellet -- nor do you get a lot of ache either ). What you do get it great warmth and blood flow -- and for many hours -- that could really help with rehabbing all those bitty bits that need rehab after surgery.

I know compounding pharmacies could just sell Alprostadil solution at high enough strength to do this sort of thing and might be pretty cheap (but they might not charge a cheap price!). Alprostadil does cost about $1000 per gram on Alibaba so we are not talking real cheap, but a little (1000 mcg) goes a long way.

So ... a little thinking outside of the needle-and-vial for anyone to pursue.

J

Post Edited (Jstars) : 6/1/2017 9:54:12 PM (GMT-6)

TA,

Yes it is crazy-ass moneygrubbing from the suppliers of MUSE or CAVERJECT or EDEX...

But i hear in France you get it FOR FREE in their health system -- go figger.

Yes you could probably use a syringe with no needle and finely sanded at that! .. or a turkey baster ;-)). And I use bacteriastatic water ... but probably any will do (but who would want chlorinated!??)

I still have little plastic applicators with the end shaped like a mushroom -- which are mashed against the urethra/glans and the liquid injects in. The thing is keeping the darn stuff in for a while which means pressing/pinching the glans shut for quite a while (and as you get firmer it wants to come shooting out).

But it does work ... something good to try when going to bed ... combining this with REM sleep when erections tend to happen makes a double good rehab I suppose.

J

Post Edited (Jstars) : 6/4/2017 11:23:16 AM (GMT-6)