After reading this article to the end, you will learn:
— about postoperative complications of patients with Peyronie’s disease,
— about the goals of rehabilitation treatment after surgical therapy of patients with Peyronie’s disease,
— about the role of physiotherapy in rehabilitation after operations,
— about the opportunities and benefits of physiotherapeutic complex “AndroSPOK” used for postoperative rehabilitation of patients with Peyronie’s disease.
After surgical treatment of Peyronie’s disease, the penis will not be as perfect as before the development of the disorder.
However, the use of modern methods of rehabilitation will minimize the negative consequences of the operation, help to maintain the shape, size and functionality of the penis.
The main problems faced by patients with Peyronie’s disease in the early or late postoperative period:
- Problems associated with wound healing:
- due to the development of infection;
- due to tissue damage during surgery and long-term reduction of local blood circulation.
- Risk of edema of the preputium, paraphimosis or phimosis.
- Risk of necrotic damage to the skin.
- Risk of hematomas, bleeding in the early postoperative period.
- Problems with engraftment (risk of rejection) of biomaterial; risks associated with possible infection, wrinkling or displacement of the graft.
- Reduction of the length.
- Feeling of seams, knots, indurations in the postoperative period.
- Residual curvature during erection (in the same direction as before the operation, but to a lesser extent, or in the opposite direction — due to the so-called hypercorrection of the curvature); a slight curvature up to 20 degrees is considered acceptable.
- Possible recurrence of erectile deformation in the late postoperative period.
- Resistant pain syndrome.
- Deterioration of erectile function, development of erectile dysfunction (sometimes — up to complete impotence).
- Reduced sensitivity of the penis head.
Reduction of sensitivity of the head and the development of erectile dysfunction is a potential risk of any surgery on the penis associated with the release of the neurovascular bundle (it is relevant for the surgical treatment of Peyronie’s disease as well). To a greater or lesser extent, a decrease in the sensitivity of the head in the release of the neurovascular bundle occurs in each patient! Recovery of sensitivity usually occurs within a few months after surgery. The use of the “AndroSPOK” device will reduce the recovery time and help to achieve better results.
In addition, since there is a significant risk of recurrence of Peyronie’s disease, postoperative rehabilitation should be recommended to the patient. Rehabilitation of erectile function, prevention of shortening of the penis, prevention of recurrence of erectile deformation are crucial for the rehabilitation therapy.
Massage of the biomaterial area and stretching the penis in length.
This type of rehabilitation is used after lengthening operations. Massage of the graft area along with penis stretching therapy is carried out by fixing the head and pulling it gently and repeatedly from the body with one hand, while gently massaging the graft area with the other hand. This procedure is recommended to start 2 weeks after the surgery and perform twice a day for 4 weeks. Massage of the graft area and stretching of the penis in length can be performed by the patient himself or together with his sexual partner, so that the partner is also actively involved in the rehabilitation process, which will reduce the anxiety associated with the restoration of sexual activity for both partners.
Phosphodiesterase type five inhibitors (PDE-5).
Prescription of drugs from the group of PDE-5 inhibitors (sildenafil, tadalafil, vardenafil, udenafil) is aimed at improving erectile function and preventing the development of erectile dysfunction conneced with surgical treatment of Peyronie’s disease (especially after operations accompanied by damaged integrity of the tunica albuginea of the penis (lengthening operations) and techniques associated with the release of the neurovascular bundle), as well as the prevention of complications associated with implant installation (improper fusion of mobile soft tissues of the penis over the tunica albuginea, etc.). This group of drugs will be useful for patients after undergoing shortening operations.
Administration of PDE-5 inhibitors before bedtime is recommended to start 5 to 10 days after the surgery (or earlier — in the absence of hematomas, severe pain during erection). The average duration of the therapy is about 6 weeks. The frequency of drug administration can be both daily and at 1 to 2 days intervals.
These drugs enhance spontaneous and nocturnal erections and thus contribute to stretching the tissues of the penis, enhance graft nutrition and, ultimately, prevent the recurrence of erectile deformation.
Stretching therapy and other physical therapy options.
In addition to taking drugs, rehabilitation of patients after surgical treatment of Peyronie’s disease includes stretching therapy and other options for physical therapy.
The use of penile extenders for traction therapy or vacuum erection devices for local negative pressure therapy can reduce the risk of postoperative shortening. Such rehabilitation therapy is possible after complete wound healing, usually 3 to 4 weeks after surgery or later.
As part of the rehabilitation course, the extender (penis stretching device) is recommended to be worn from 2 to 6 hours a day for 3 months or more. Numerous studies have confirmed the positive result of the use of external penile traction not only in conservative treatment, but also in the postoperative period, as stretching of the penis reduces the risk of postoperative shortening.
The use of vacuum erection devices provides stretching of the penis in all directions, thereby increasing not only its length but also the diameter. In addition, the use of vacuum erection devices is more convenient for postoperative rehabilitation of patients with fibroplastic penile induration, because, firstly, it allows reducing the time of the procedure to 20 minutes a day, and, secondly, it makes it possible to combine vacuum erection therapy with other highly effective factors of physical impact: in particular, with magnetotherapy and phototherapy (the use of phototherapy factors).
“AndroSPOK” magnetophotobarotherapy device combines the capabilities of low-frequency pulsed magnetic therapy, optical polarized effects of visible and infrared (phototherapy), local vacuum therapy (barotherapy).
In addition to traction impact (stretching therapy), the use of the “AndroSPOK” device allows for a combined magneto- and phototherapy, which speeds up recovery and increases its effectiveness.
The main effects of magnetotherapy when using the “AndroSPOK” device in postoperative rehabilitation of patients with Peyronie’s disease:
trophicity-stimulating effect (the improvement of local blood circulation activates cellular nutrition);
reparative and regenerative effect (activation of growth of healthy tissue and restoration of damaged tissue);
hypotensive and desensitizing effects.
Moderate sedative and hypotensive effects are observed after 1-2 procedures. After 3-5 procedures analgesic and anti-edematous effects develop. For the manifestation of trophicity-stimulating, anti-inflammatory, persistent vasodilator and desensitizing effects 8-12 or more procedures are required.
The course of treatment using the “AndroSPOK” device can include from 10 to 30 procedures. The duration of the procedure is 20 minutes. Procedures are carried out daily or at 1 – 2 days interval. Courses can be repeated every 6 – 8 weeks.
Since the energy of the magnetic field is absorbed primarily by the nervous tissue, the use of magnetic therapy after surgical treatment of fibroplastic penile induration provides reliable prevention of neurogenic erectile dysfunction, which can occur in connection with damage to the neurovascular bundle.
In addition, the optical polarized effect of the visible and infrared ranges on the penis head improves its innervation and thereby accelerates the restoration of sensitivity, increases it.
In the postoperative rehabilitation of patients with fibroplastic penile induration, early restoration of sexual life is of great importance. This plays an important role in the adequate work of the cavernous bodies and the prevention of cavernous fibrosis. Systematic use of the “AndroSPOK” device will ensure artificial activity of cavernous bodies (due to the cyclic creation of passive erection under the influence of local negative pressure), improve local blood circulation, guarantee the training of blood vessels, protect against cavernous fibrosis. Improvement in erectile function and increase in the sensitivity after surgical treatment of Peyronie’s disease will create conditions for a speedy return to active sexual life without restrictions.
Long-term use of the “AndroSPOK” device after surgical treatment of Peyronie’s disease will contribute to the softening and resorption of scars, reduce the residual curvature, minimize the risk of relapse, and will be good to prevent erectile dysfunction and some other disorders of the reproductive system (eg, chronic prostatitis).