The Cause of Urinary Leakage in this population is primarily due to RADIATION FIBROSIS (Tissue stiffness/increase rigidity and decreased elasticity) of the following areas:

• • Muscle – compromised contractility and control of PFMs
  • Urethra – Fibrosis/ Stiffness
  • Vascularity – mucosal vascular changes 
  • Bladder – Fibrosis/ Stiffness ( decreased bladder capacity and decreased bladder volume at first urge 18 months post RT)

BUT EXERCISE MAY BE THE SOLUTION TO PREVENT FIBROTIC CHANGES IN PFMs AND MANAGE INFLAMMATION

• CPPS or Non Bacterial Prostatitis is the most common urologic diagnosis in men older than age 50 years and is the third most common diagnosis in men younger than age 50 years.

• The Pudendal nerve is the main nerve supplying the genitalia, bladder and rectum can become irritated due to prolonged cycling and/or sitting

• Is the result of the kidneys filtering too much bodily fluids
• High blood pressure and cardiac disease increase demand on kidneys
• Sugar and Sodium cause an increase in fluid retention for 2 hours before the kidneys will start to filtering the fluid. Therefore pay attention to what you are eating in your last meal before bed.
• Taking beta blockers can also influence bladder capacity, however we can’t change this one because patients require this medication to manage their disease
• Alcohol can significantly affect one’s sleep which inhibits the release of necessary hormones that prevent urine production through the night

VACUUM ERECTION DEVICES (VED’S) – PATIENT INFORMATION

Intended Audience : Post Prostatectomy Patients

 

1. This treatment has been shown to be highly effective, regardless of what’s causing the erectile dysfunction (ED).
2. Reported satisfaction rates vary between 35% to 84%.
3. Can be a useful addition to PDE5i (Viagra, Cialis), and/or injection therapy following removal of the prostate, also known as a Radical Prostatectomy (RP).
4. Work best if the man has had one or both nerves sparred during the surgery
5. Improved results can occur when both parties have a positive attitude towards its use and receive sufficient instructions. 
6. Should be started 1-2months following RP.
7. Penile Traction Therapy using VEDs can maintain the length of the penis by possibly improving erection mechanisms and preventing structural changes.
8. Starting to use a VED one month after a RP can improve sexual function in the early stages and maintain the length of the penis through a process known as traction therapy.

Toussi, A., Ziegelmann, M., Yang, D., Manka, M., Frank, I., Boorjian, S. A., Tollefson, M., Köhler, T., & Trost, L. (2021). Efficacy of a Novel Penile Traction Device in Improving Penile Length and Erectile Function Post Prostatectomy: Results from a Single-Center Randomized, Controlled Trial. The Journal of Urology, 206(2), 416–426. https://doi.org/10.1097/JU.0000000000001792

Köhler, T. S., Pedro, R., Hendlin, K., Utz, W., Ugarte, R., Reddy, P., Makhlouf, A., Ryndin, I., Canales, B. K., Weiland, D., Nakib, N., Ramani, A., Anderson, J. K., & Monga, M. (2007). A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy. BJU International, 100(4), 858–862. https://doi.org/10.1111/j.1464-410X.2007.07161.x

 

Contraindications include:

1. Bleeding disorders such as excessive bleeding, blood clotting/clumping, and sickle cell anemia.
2. Concurrent anticoagulant therapy – taking more than one medication that helps prevent blood from clotting.
3. Anastomotic Dehiscence – medical term that refers to the separation or opening up of a surgical connection between urethra (the tube that carries urine from the bladder out of the body) and the bladder neck after the prostate gland has been removed.

 

Possible adverse effects include:

1. Bruising
2. over-stretching/micro-tearing of the penile tissue
3. Local pain
4. Failure to ejaculate – for men who still have their prostates.
5. Coldness of the penis
6. Urinary leakage can occur during use of the VED if urinary control has not been achieved following RP
7. Numbness
8. Altered sensation
9. Discoloration
10. Dysorgasmia (pain or discomfort during or after orgasm)
11. Petechia (Small flat purple circular marks that appear on the shaft of the penis)

 

Recommendations:

The VED constriction ring should not be worn for more than 30 minutes to prevent possible irreversible damage, and a break of at least 60 minutes should be taken between uses to allow full restoration of the penile blood supply. If a condom is to be worn, is should not be used during the vacuum process, but put on as a last step. It is also recommended that you consult your health care provider to rule out any underlying serious pathology. Please also note that if you have Peyronie’s disease (a curve or bend in the penis that results from the formation of plaque or scar tissue inside the penis) this device may not be suitable for you.