Penile Afferent Vascular Stimulation (PVS) also known as (TMNS) is recommended today by many urologists and prostate cancer surgeons as an option for Penile Rehabilitation and Urinary Control/Continence After Radical Prostatectomy (RP) and Chemotherapy-induced Neuropathy.
Male reproductive functioning is highly dependent on the neurological integrity of the pelvic floor and the spinal nerves. Erectile function and ejaculation are diminished in patients with neurological damage from conditions such as prostate surgery, including diabetes mellitus, multiple sclerosis , trauma and congenital disorders of the spinal cord . Furthermore, neurological problems can cause impairments in sperm quality in prostate intact men.
Erections are initiated by a combination of psychological and physical stimuli. Erectile function is controlled by parasympathetic fibers originating from S2 to S4. These fibers travel through the pelvic nerve and the pelvic plexus to the cavernous nerve, which enters the corpora cavernosa. As these fibers pass through the pelvis, the nerves run in close proximity to the prostate and rectum, which makes them prone to injury during surgical procedures.
When activated with afferent penile stimulation, the cavernous nerves release nitric oxide and acetylcholine, both of which induce relaxation of the smooth muscle tissue by inducing cyclic guanosine monophosphate and cyclic adenosine monophosphate, respectively, which in turn results in calcium efflux. This causes a massive influx of penile blood flow to the tissue. Through a shear stress mechanism induced by this blood flow, the endothelium releases more nitric oxide that causes an erection to reach a maximum and then maintains that erection.
Increased intracavernosal pressure then compresses the small venules, which results in blood trapping and contributes to maintaining the erection.
The activation of basic sympathetic tone following afferent therapy results in the contraction of smooth muscle, which results in the penis returning to a flaccid state. Moreover, phosphodiesterase 5 (PDE5), which is abundant in the penile tissue, contributes to this process by breaking down cyclic guanosine monophosphate. Important in preventing Priapism.
Ejaculation is the result of coordination of both psychological and physical sexual stimulation. The ejaculatory reflex is coordinated by the spinal nerves and depends on thoracolumbar sympathetic fibers from segments T10–L2 and somatic fibers from segments S2–S4. This reflex receives its somatic input primarily from the dorsal nerve of the penis, which is activated by stimulation of afferent therapy to the glans penis. Neurons in the cortex, thalamus, hypothalamus, midbrain and pons, all play a role in ejaculation, to which PVS actives both the dorsal and ventral penile nerves.
Prior to ejaculation, sperm cells that are stored in the epididymis are transported to the vas deferens by means of contractions of smooth muscle tissue. This is followed by coordinated contractions of the vas mediated by the sympathetic fibers. The contractions move sperm through the vas to the ejaculatory ducts, which also have an inlet from the seminal vesicles. Along with seminal plasma from the seminal vesicles and prostate, the sperm cells are then transported to the urethra from which they are expelled in a projectile manner as somatic nerve fibers induce contractions of the pelvic/periurethral muscles. During ejaculation, the bladder neck closes and the external urethral sphincter opens.
Given that erection and ejaculation are separate events and that the neurons responsible for the two events are different, penile afferent therapy provides simultaneous stimulation of both surfaces of the penis, the dorsal and ventral, rehabilitating and activating both the erectile and ejaculatory ( afferent and efferent) mechanisms.
Pelvic trauma and pelvic surgery can cause direct damage to the pelvic floor nerves and disrupt neurological mechanisms responsible for erection and ejaculation. While prostatectomies and cystectomies can cause nerve damage, their influence on anejaculation is due to more than just neurological reasons, as accessory sexual glands and semen pathways are removed during these surgeries.
Rectal surgery can create problems due to damage of the peripheral nerves and to damage of the superior hypogastric plexus. Thus, ED is often seen in patients after radical rectal surgery. Other types of surgeries can cause damage to the lumbar sympathetic ganglia, the superior hypogastric plexus and fibers from both of these structures. These surgeries include periaortic surgeries, such as aneurism or bypass procedures, trauma surgery, any retroperitoneal lymph node samplings, and, in particular, retroperitoneal lymph node dissection in conjunction with testicular cancer.
The classical retroperitoneal lymph node dissection removes post-ganglionic sympathetic nerves and the hypogastric plexus, which are necessary in normal ejaculation. Nerve-sparing retroperitoneal lymph node dissection has been developed to preserve these structures. However, high rates of post-surgical ejaculatory dysfunction are still evident with high tumor burdens from surgery and after chemotherapy.
Men with surgical injury to the neurovascular bundles suffer from a continued cycle of smooth muscle cell death, leading to veno-occlusive disease after radical surgery. Men with preserved neurovascular bundles may also have progressive fibrosis of the cavernosal tissue causing venous leakage. The afferent therapy helps to decrease the fibrotic changes associated with nerve dysfunction and helps promote the regeneration of nerves for a functional recovery.
Recent clinical reports have demonstrated that penile vascular stimulation can also reduce urinary bladder dysfunction (detrusor hyper-reflexia), decrease intra-bladder (intra-vesical) pressure and also increase bladder capacity. The reported effect on urinary bladder reflex activity have implications in the management of incontinence and in men at risk for upper urinary tract deterioration due to high storage pressure in the filling phase. Stress urinary incontinence and/or detrusor irritability can be improved by regular afferent penile nerve stimulation leading to improved urinary control and symptoms by adaptive conditioning.
FDA Indications: PVS is a Class II medical device and doctor recommended.
CE Indications: Penile vibratory stimulation device for the treatment of erectile and ejaculatory disorders (prescription use).
Treatment and holistic consultation includes the option to ” Rent or purchase PVS.”
PVS attains improved intracorporal penile blood flow at Suprasystolic Pressures of 230 mm Hg , rehabilitating the penile nerves; for preventing atrophy of the penile muscle; improving ejaculatory reflex response, urinary control, sperm motility and fertility and the regeneration of nerves damaged in surgeries.
The technique is typically performed initially in a clinical setting, however distant care can also provide holistic consultation and in depth instruction so it can be performed correctly in the comfort of your own home.
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While PVS is a stand alone therapy for erectile dysfunction, it should be used in conjunction with a holistic protocol, especially for promoting healing of the myelin, healing from surgical damage, radiation damage, chelation therapy from toxic chemotherapy, chelation from environmental toxins in semen, for pathology of ejaculatory problems, primary disease and disorders, for promoting spermatogenesis, anti-inflammation, immunoprotective, radioprotective, neuroprotective, for promoting neurogenesis and reproductive ( sexual) function.