VED protocol post implant surgery

[TonySa]

Can any one share any post implant VED protocol they were given by surgeon?  Also, what the rationale for it is?  

I thought it was probably contraindicated even though some surgeons recommend it (at least one study written) until I saw the AMS post surgery patient video which mentioned it.  So, at least not banned by the manufacturer.  https://youtu.be/1JMc2qWApmQ


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708606/
"In a separate case report, a patient with post-PPI penile shortening underwent vacuum erection device therapy twice daily for 10 minutes per session for approximately 1 year as well as 8 hours of penile traction therapy daily for 8 months. At the time of PPI revision, a prosthesis that was 20% longer in length was used which improved erect penile length by 4.4 cm. The post-PPI traction therapy also increased SPL by 2.3 cm (27)."

See reply #18 below.

[TonySa]

Here's what I've heard back from others elsewhere:

" I don't have what you are looking for BUT, In the past two weeks I have spoken to Dr. Eid, Dr. Perito, Dr. Kramer and Dr. Brock... all support VED therapy except Dr. Kramer, who is indifferent. Dr Perito says pump it up to where it's comfortable but the next pump would not be. Leave it 20 minutes. Do this twice a day."

Can anyone confirm any of these docs have told them the same?  I'm especially interested in what Dr Eid has to say.

UPDATE: DR KRAMER AND DR EID DO NOT recommend post implant VED use.

[Hawk]

I have no clue who said that but I can assure you Dr. Eid does NOT recommend post-implant VED protocol.

I have discussed this with him in a sitdown visit.  Since I originally got him to say I could use a VED but no band.  I took one of my static VED rings and asked if I could use it.  He looked at it and said yes.  Keep in mind that Dr. Eid does not even recommend cycling once intercourse begins.  Dr. Eid feels that he does all that can be done to get the size for his patients.  The patient needs to cycle early (day 3) up until intercourse starts about day 21.  After that, he says save the wear and tear on the implant because it will make little difference on your size.  I do not necessarily agree, however, it could depend on one's definition of  "little difference in size"  So I do NOT believe Dr. Eid endorses a post-implant VED protocol.

Since he graciously consented to respond to any questions I felt a need to forward to him, I will ask, however.

I am very interested in the name of who said that since I can guess that it was on another forum.

[TonySa]

Larry 🙃

[Hawk]

I figured.  

[Alibaba]

I do question the 'sudden' social affiliation between said person and some of the top doctors lately as well as some of the opinions presented as 'fact'.   I do often have correspondence with implantees and several though, have told me their doctor recommended or they on their own had success using the vacuum pump cylinder to assist their AMS implant.  Being the implant supposedly grows to the desired pre implant size over a 2 year period, maybe that _*&^)%($( thing needs additional assist devices to finally expand to a reasonable functional state.  If it is true, and if I had known it when I had that puny 21cm LGX, I would have sucked that bitch off my body with my pump to try to get it useful.  Is it possible so many are disappointed in the pathetic state of the AMS/BS implant they are grasping straws or do doctors do such a sloppy job of installation expecting eventual expansion to make up for their inadequate processes?  Since the Titan seems to be a "what you see is what you get" implant w/o need for sucking it to an eventual size, maybe that is why Dr. Eid told you that you do not need to use a Hoover on your dick Hawk. Cheers.

[Pfract]

@TonySa: i read the same post on FT too. I have serious doubts he was speaking with all of those doctors. I mean, i still remember the ethnic cleansing there was in 2017, due to people supporting EID/Kramer, and now he is corresponding with all of them as if they are his buddys? on a topic like this? VED post implant? like what, all of the sudden he is interested on it? I was almost about to ask him where is his proof. For him to take a couple of screenshots, with the names and addresses blurred out, so he could prove it out. But i guess we all know what happened last time folks started requesting proof over there. Donnie and his amazing stretching routine that would make your penis GROW VOLUMES comes to mind. Along with him throwing a fit like a 12yo that he was being cornered and bullied to provide evidence of something he was 100% sure it worked, but he had no necessity to prove. JUST ACCEPT THE FACT OKAY?

damn this triggers me so much..... I hope one day we on this board are able to come up with a protocol or path, to help out people in need of regaining size. Whether it is before or after the implant with traction and VED independently or combined. I remember a medical paper i read on pubmed, of a guy that was implanted and he was medically considered to small to have intercourse. His doctor recommended he used traction daily, to try to regain size. After allmost a year of daily traction, he was able to regain back a few cm, and had a bigger implant installed, being able to have successful intercourse.

Now i ask... why aren't more man interested on this? sure, i get that folks who are sized okay, and are around the same size they were pre implant might not be interested. But what about those men that lost a lot of size because of atrophy due to Radical Prostatectomy? shouldn't they be up in arms, trying to do everything they can? reading every paper? trying everything in their power? I don't get it. I seriously don't. And i add that sometimes i go to the FT chat, and people talk about everything but implants or technical issues that concern them.

Sorry for the rant guys. But i add, that i would love to hear your comments on it.  

https://www.ncbi.nlm.nih.gov/pubmed/21091884

Revision of penile prosthesis surgery after use of penile traction therapy to increase erect penile length: case report and review of the literature

Abstract

INTRODUCTION:
Erectile dysfunction, a common consequence of radical prostatectomy (RP), can be managed with placement of a penile prosthesis. Patient satisfaction and functional outcomes have been related to penile length after prosthesis placement.
AIM:

We report a case demonstrating the impact of daily penile traction therapy in a patient with a previously placed penile prosthesis with the goal of enabling revision with a longer device.

METHODS:
A post-RP patient who underwent inflatable penile prosthesis placement 6 years ago complained of inability to maintain partner penetration with his device. The patient underwent vacuum erection device therapy twice daily for 10 minutes per session for approximately 1 year as well as 8 hours of penile traction therapy daily for 8 months. A revision implant surgery was subsequently attempted.
MAIN OUTCOME MEASURE:

Patient reported functional outcome.

RESULTS:
Stretched penile length increased 2.3 cm after 6 months of traction therapy. A revision surgery enabled the placement of a prosthesis that was 20% longer in length (15 cm to 18 cm), and erect penile length increased by 4.4 cm. The patient reported that the new prosthesis enabled satisfactory maintenance of partner penetration.

CONCLUSIONS:
This case suggests that the use of a penile traction device increases penile corporal length, and thus the length of a penile prosthesis that can be implanted in a patient with an unsatisfactory prosthesis already in place. Importantly, this patient experienced a substantial improvement in erect penile length after surgery. It is unknown whether these results are generalizable, either to all patients with a previously placed prosthesis or pre-prosthesis patients, representing an opportunity for further investigation.

https://www.ncbi.nlm.nih.gov/pubmed/21492409

Traction therapy for men with shortened penis prior to penile prosthesis implantation: a pilot study.


Abstract
INTRODUCTION:
Loss of penile length after penile prosthesis implantation is one of the most common complaints. There is no recognized reliable technique to gain length once the device is placed.

AIMS:
This noncontrolled pilot study was designed to evaluate the efficacy and safety of external penile traction therapy in men with a shortened penis used before inflatable prosthesis implantation.

METHODS:
Ten men with drug refractory erectile dysfunction and a complaint of a shorter penis as a result of radical prostatectomy in four, prior prosthesis explantation in four, and Peyronie's disease in two were entered into this trial. External penile traction was applied for 2-4 hours daily for 2-4 months prior to prosthesis surgery.

MAIN OUTCOME MEASURES:
Baseline stretched penile length (SPL) was compared with post-traction SPL and postimplant inflated erect length. A non-validated questionnaire assessed patient satisfaction.

RESULTS:
All men completed the protocol. Daily average device use was 2-4 hours and for up to 4 months. No man had measured or perceived length loss after inflatable penile prosthesis placement. Seventy percent had measured erect length gain compared with baseline pre-traction SPL up to 1.5 cm. There were no adverse events.

CONCLUSION
External traction therapy appears to result in a preservation of penile length, as no man had measured or perceived length loss following prosthesis placement, but in fact, a small length gain was noted in 70% of the subjects with no adverse events. The protocol is tedious and requires compliance to be effective. External traction therapy prior to inflatable penile prosthesis placement appears to preserve and possibly result in increased post-prosthesis implant erect length.

https://www.ncbi.nlm.nih.gov/pubmed/26816726

Strategies for maintaining penile size following penile implant.

Abstract
INTRODUCTION:

Loss of penile size is a common complaint that can negatively affect patient satisfaction rates following successful penile prosthetic implant surgery.
OBJECTIVE:

The aim of this review is to describe the various strategies that have been used to maintain penile length or girth after the insertion of a penile prosthetic implant.

METHODS:
An extensive systematic literature review was performed, based on a search of the PUBMED database for articles published between 2002 to 2012. The following key words were used: penile prosthesis, implant, penile length, size, penis, enhancement, enlargement, phalloplasty, girth, lengthening, and augmentation. Only English-language articles that were related to penile prosthetic surgery and penile size were sought.

DISCUSSION:
Based on the results of our search, strategies were classified into 3 groups based on the timepoint in relation to the primary penile prosthetic insertion surgery, which included pre-insertion, intraoperative and post-insertion.

CONCLUSIONS:
Strategies to preserve and potentially increase penile size are of great importance to all implanters. Besides traction therapies and surgeries to enhance perceived penile size, refinements in the surgical approach are simple ways to optimize penile length. A direct comparison of treatment outcomes evaluating the various approaches is not currently possible, owing to divergent study techniques. The implanting surgeon can best serve his patient by adopting a combination of different strategies that are individualized and specific to the patient's needs.

[Hawk]

I typed a whole response on my iPad and lost it with an attempt to spell check.  Here it goes an attempt to reconstruct it on the PC.

I used maximum tension traction for many years (for months off and on).  I did so at maximum tension with a heavy-duty spring upgrade.  Toward the end, I got no increase from it.  I continued the last few months prior to implant and stopped two days before implant (to assure no abraded skin for potential bacteria).  During that time I continued to manual stretch.  I also used the VED.

Since implant surgery, I have experimented with the VED.

I put on a static VED band (washer).  I inflate my implant to about 45% capacity.  I use the VED until my glans and spongiosum are engorged.  I remove the VED but leave the band in place and continue to pump my implant to full inflation. At this point, my penis looks like it is going to explode but I have no pain.  I leave it like this for about 20 minutes.  I have never done this for sex but that was a big part of why I experimented.

One concern I have is the base of the VED pressing so deeply into the pubic cushion and scrotum. I fear this is putting excessive tension on the tubing which is the weak part of a Titan.

[p-diddy]

Very interesting debate.  I never used a VED with rings, only a manual VED to do some stretching for the Peyronies and pre-op.  One thing I remember is that when that thing is really engaged with suction, it puts a lot of pressure all around the base of the penis and tends to want to suck up the scrotal skin under the penis.  It seems with the tubing in the scrotum and the tubing going into the reservoir that this could be damaging to the plumbing.  
Also, at least with the Titan, the cylinders aren't going to expand beyond their capacity and if you are properly sized there is going to be no significant gain in length.
Maybe there could be some improvement in girth or engorgement of the glans however.  Whether temporarily or permanent?  I don't know.  
It's just kind of a sad commentary on the whole thing when men take the plunge to cure ED with the ultimate solution and are still resorting to using the VED.
Also of note, I have been on FT for some time.  I journalize over there as well.  With the large number of people on there, I get very little feedback on my journal.  When I do, it's usually stuff off point from the content of my post.  They really don't seem interested in reading the actual story and progress of a guy going through this.  I can only hope there are a lot of guys on there who are lurking and reading but not posting so hopefully I'm helping someone.  Very odd bunch over there with all due respect.

[FloppyNoMore]

As of October 26 2018 Dr. Eid told me that the use of a VED after an implant was not of any benefit and it could cause damage to the pump and tubing. My suggestion is to get a good BJ once in a while and skip the VED. Much more satisfying and less likely to cause any damage.  

[Hawk]

Depends on who is giving it. LoL .  BJ's can be dangerous.  

[Hawk]

As of October 26, 2018, Dr. Eid told me that the use of a VED after an implant was not of any benefit and it could cause damage to the pump and tubing.

This confirms exactly the impression I had that Dr. Eid certainly does NOT endorse or recommend a VED protocol.   HE does allow you to use a VED if you think it will give you some fullness to your glans if you cannot get that and it matters a lot to you.  I will get the response from him in writing.

The poor guys on the other forum will unfortunately just be misled by yet another bucket of made up BS. That's why they should all be here and why we should not prop that forum up by posting.  In my opinion, it is just like baiting a trap to lure more unsuspecting men in.  If you are concerned about them as I am, send them a PM with a link inviting them here.

IMO  

[Alibaba]

But there will be a book available to help you through your depressed state after you ruin your home mortgaged implant. Most valuable information on page 176 if you last that far.  

[TonySa]

I spoke with Dr Karpman today.  He does not recommend post implant VED and believes it could blow out the cylinders.  He says if a patient is undersized the only way to address this is revision therapy.

[Pfract]

@tonysa: I don't mean to discredit you, or your doctor in any way. I believe he might indeed be of that opinion. But... we have some studies showing the opposite, and also some doctors (supposedly) being okay with it. I remember a few posts of members of FT that tried it, with the implant installed, and inflated and even posted there a picture or two. We have also seen a dramatic improvement with a traction device, namely "restorex", from user "thinkpositive"...

@p-diddy:

"Also, at least with the Titan, the cylinders aren't going to expand beyond their capacity and if you are properly sized there is going to be no significant gain in length. Maybe there could be some improvement in girth or engorgement of the glans however.  Whether temporarily or permanent?  I don't know.  

Well, i've read a few articles from respected doctors on titan implantees having bigger implants installed upon revision. That and also the twice a day cycling making you gain back some length, albeit at a slight cost of implant life. (supposedly?).

https://www.ncbi.nlm.nih.gov/pubmed/28537700

Inflatable penile prosthesis as tissue expander: what is the evidence?

OBJECTIVE:
Many patients who undergo inflatable penile prosthesis (IPP) replacement are often upsized to larger cylinders, suggesting the IPP may serve as a tissue expander and increase internal penile length. The objective of this study is to evaluate whether cylinder length increases with subsequent IPP insertion.

MATERIALS AND METHODS:
We queried American Medical Systems and Coloplast Patient Information Form databases to identify patients who underwent IPP placement and replacement between 2004-2013. Patients were grouped by device type and time to replacement (<2 or ≥2 years). We selected the 2-year mark for subgroup analysis to allow time for tissue expansion to occur and to exclude patients who underwent early explantation (e.g. erosion or infection).

RESULTS
Two thousand, seven hundred and forty nine patients (1,532 AMS 700 LGX, 717 AMS 700 CX, and 500 Coloplast Titan) met the inclusion criteria. Mean time between implants was earlier for LGX (29 months) than CX (39 months) and Titan (48 months) patients (p<0.001). Patients who underwent device replacement at <2 years did not experience an increase in mean cylinder length. On the contrary, patients who underwent device replacement at ≥2 years did experience significant increases in mean cylinder length (LGX 1.2 cm, CX 1.1 cm, and Titan 0.9 cm, p<0.001). The mean increases in length at ≥2 years were similar between the 3 devices (p=0.20). Sixty percent of patients demonstrated increases of >0.5 cm and 40% demonstrated increases of ≥1 cm.

CONCLUSIONS:
As demonstrated, the IPP may provide tissue expansion over time. Further evaluation is needed to determine if increased cylinder length correlates to increased functional length and patient satisfaction.

https://www.ncbi.nlm.nih.gov/pubmed/26459782

Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis.

Abstract

A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements. This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer (30.8%) or the same (46.2%) as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject (96.5%) was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.

[/b]

I've highlighted in bold, inportant parts of the abstract and the conclusion of the article.  On a side note, i wonder if we should encourage members of this board to cycle like this? O.o

@hawk:

I put on a static VED band (washer).  I inflate my implant to about 45% capacity.  I use the VED until my glans and spongiosum are engorged.  I remove the VED but leave the band in place and continue to pump my implant to full inflation. At this point, my penis looks like it is going to explode but I have no pain.  I leave it like this for about 20 minutes.  I have never done this for sex but that was a big part of why I experimented.

You say you leave the tension band on. I presume the purpose is to retain the blood/expansion you have achieved with the VED, before taking it off? One thing that just ocurred me, is that WE, and i say we as a community could MAYBE recommend this method for when a patient is awaiting it's revision after is current implant has failed? Say you have a titan, used it for a couple of years, then one day the pump goes flat and you know you need a new one.

Thank you all for commenting on this. It is a subject which i am deeply enthused to discuss. Really means a lot to me.

[Hawk]

The times I used the VED it may have stressed the tubing but did not endanger the cylinders.  I used the VED with the cylinders half full.  No fluid was drawn into the cylinders with the VED. It was only after getting maximum with the VED that I even inflated the implant cylinders.  Good/bad/healthy/dangerous, It is a powerful stretch.  To me, the only advantage of more length at this point is less internal folds when deflated.  I doubt my wife of 50 years is going to pack up and leave because I don't make 7 1/4"     -  I have never seen whether the "recommended" protocol is the VED on an inflated implant or VED on a deflated implant.

[TonySa]

No discredit concerns, I'm only reporting what Dr K indicated to me.  It does seem this may not be a concern if one inflated after VED expansion as Hawk states.  I'm only looking to see what the various recommendations are that are out there.  The articles you cite though are not about VED use from what I read.  I appreciate all viewpoints and comments on this topic.

[Alibaba]

Dr. Karpman has earned the designation of being reputable and well respected by his patients. I think his take may be coming from his being an AMS/BS implanter preferably. The AMS failures seem to be most common from herniation or rupture of the cylinders. This might be from silicone being a more pliable material plus the bi-directional expansion allowed by the fabric layer allowing a rupture. The Coloplast is most observed to fail at the pump or reservoir tubing connections. I tend to believe that just like in vacuum pumping before you have an implant, moderation should be your guide. If you are getting swollen tissue or cell ruptures (red spots), you are over doing it. It is one thing to give your implant some assist, especially the LGX. It is another to try to suck your dick to reach down to your knees.  You car engine won't last as long if you constantly drive it for hours on end at 140mph either. Common sense goes a long way. Cheers.  

[TonySa]

Postoperative vacuum therapy following AMS™ LGX 700® inflatable penile prosthesis placement: penile dimension outcomes and overall satisfaction.

Link: https://www.ncbi.nlm.nih.gov/m/pubmed/30745567/#fft
https://www.ncbi.nlm.nih.gov/m/pubmed/30745567/


Instructions were;
After discharge patients were taught how to activate and deactivate the device at a median of 8 (range 5–12) days following surgery. They were encouraged to cycle it twice daily 10–15 min per day. Starting 3 weeks after discharge, patients were asked to use a vacuum device for a 12-week period (Medis®, Vacuum Therapy Devices, Milan, Italy and Osbon ErecAid®, Vacuum Therapy System, Collierville, TN, USA) without the constriction ring for 5min twice daily after full device inflation was achieved.

[TonySa]

https://irp-cdn.multiscreensite.com/d8865058/files/uploaded/Postoperative%20vacuum%20therapy%20followin%20g%20AMS%20LGX%20700%20inflatable%20penile%20prosthesis%20placement_%20penile%20dimension%20outcomes%20and%20overall%20satisfaction.pdf