Other Modes of Treatment of ED
The earliest effective treatment for organic impotence was the penile implant, successfully performed for the first time in 1947 using a single rigid plastic strut surgically inserted into the penis. Previous surgical efforts using a piece of rib or cartilage had failed because of rapid breakdown and absorption of the implant by the body. Although the plastic strut allowed some men to resume coitus, it was the introduction of medical-grade silicone in the 1960s that ushered in a truly practical surgical solution. The single flexible silicone rod was quickly followed by the introduction of more anatomically correct semirigid rods that bend like pipe cleaners, allowing manual positioning of the penis into an erection. Soon afterward, a three-component inflatable device was designed. The components include a bulb placed inside the scrotum, an inflatable cylinder positioned inside the penis and a saline sack inserted into the abdomen. Pumping the bulb causes fluid to fill the cylinder, bringing about rigidity. A release valve in the bulb allows a return to the flaccid state. Today three companies in the U.S. manufacture a variety of semirigid and inflatable prosthetic devices.
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The average age of a patient choosing a prosthetic is 50. Implants seldom wear out, even after decades of use; each implant carries a manufacturer’s lifetime guarantee. Implants are safe and almost 100 percent effective. In addition, the approach offers a particular advantage not present in any other impotence treatment currently on the market: it allows coitus without prior planning. That fact greatly increases the overall satisfaction of the men and their partners who choose this option.
Another mechanical treatment is a vacuum pump, a temporary, nonsurgical approach that works on the same principle as milking machines placed over a cow’s udder. Pumping air out of an airtight chamber covering the penis creates a vacuum, which draws blood into the penile sinusoids. A tourniquet is placed at the base of the penis to trap the blood in the phallus after removal of the vacuum chamber. Though safe, the instrument produces varying degrees of penile rigidity for each man and during each episode of use.
Penile Injections
The next major treatment Canadian Pharmacy Viagra advance was hit on by serendipity: in 1979 French vascular surgeon Ronald Virag accidentally injected papaverine rather than saline into a patient’s penis during a diagnostic procedure. To his (and probably the patient’s) surprise, the man became erect. Virag quickly recognized the utility of papaverine, a drug used to induce smooth muscle relaxation. After confirming the reproducibility of triggering an erection, which occurred minutes after intracorporal injection of the drug, Virag announced his findings. This discovery highlighted for the first time that smooth muscle relaxation was the key erectile mechanism and set the direction for the next generation of basic research. Of particular interest is that papaverine acts very far down in the chemical cascade needed for erection by increasing the concentration of cyclic adenosine monophosphate (cAMP), a chemical that helps to block the entry of calcium ions into the cell, which in turn results in smooth muscle relaxation.