Vacuum Devices and Shock Waves for Penile Prostheses

Vacuum Devices in Clinical Practice

Vacuum devices represent an effective mechanical and noninvasive therapeutic alternative in the clinical management of organic or drug-resistant erectile dysfunction.

The mechanism consists of a transparent cylinder connected to a manual or electric pump that creates a negative-pressure vacuum around the penis.

This pressure difference stimulates a massive influx of oxygenated arterial blood into the sinusoids of the corpora cavernosa.

Once an erection has been achieved, an elastic constriction band or ring is moved toward the base of the penis to block venous return and maintain the erection.

It is essential to remove the ring before thirty minutes of use have elapsed to prevent necrosis, tissue hypoxia, or pain.

Despite its high effectiveness in patients who have undergone prostatectomy or those with vascular disease, its main clinical limitation lies in the loss of spontaneity, the coldness of the glans, and the discomfort caused by venous compression.

Low-Intensity Shock Wave Therapy (Li-ESWT)

Low-intensity extracorporeal shock wave therapy (Li-ESWT) is an innovative, noninvasive technology aimed at the vascular regeneration of cavernous tissue.

Unlike palliative interventions that only facilitate a temporary erection, shock waves seek to restore biological erectile function.

By applying acoustic micro-pulses to the body of the penis and the cavernous bodies, a process of mechanotransduction is triggered that activates the release of endothelial growth factors and recruits progenitor cells.

This stimulates angiogenesis, improves microcirculation, and optimizes endothelial function and smooth muscle relaxation.

This is an outpatient procedure that is painless and free of adverse systemic effects; it is highly recommended for mild to moderate erectile dysfunction of vascular origin, and even for patients who wish to reduce their dependence on first-line oral medications.

Penile Implants or Prostheses as a Definitive Surgical Option

Penile prostheses have established themselves as the definitive third-line surgical option for men with irreversible organic erectile dysfunction who have not responded to medications, injections, or vacuum devices.

There are two main categories: semirigid or malleable prostheses, consisting of flexible internal silicone rods that are manually positioned, and three-component hydraulic and inflatable prostheses.

The latter include cavernous cylinders, an activation pump located in the scrotum, and a saline reservoir housed in the pelvic cavity, allowing for a very natural simulation of the flaccid and erect states.