Electrical Stimulation and Vacuum Device for Urinary, Bowel, and Erectile Dysfunction

The main trigger of incontinence after prostatectomy is probably secondary to sphincter damage caused by surgery to the prostate. To date, the treatment of post-prostatectomy urinary incontinence is based on lifestyle modifications and therapeutic pelvic floor muscle training (PFMT), possibly in combination with biofeedback (BFB), electrostimulation (ES), extracorporeal magnetic stimulation, and use of external devices in some cases. Single treatments or their combination have not yet demonstrated indisputable effectiveness. In general, ES is thought to inhibit detrusor contractions, thus reducing the number of contractions and potentially increasing detrusor capacity, and may activate the skeletal muscles of the pelvic floor, and it is therefore necessary to assume that ES is present for it to be effective, at least partial innervation of the pelvic floor. ES, together with physical exercise, has proven effective in the treatment of women with stress incontinence, while the same combination in male urinary incontinence after radical prostatectomy requires further confirmation. To date, further studies on the effectiveness of ES after radical prostatectomy are still needed in order to achieve recovery of urinary continence. To date, there is insufficient data in the literature to support the use of electrical stimulation to treat post-radical prostatectomy erectile dysfunction (ED). The vacuum devices (VED) proposed rationale for rehabilitation essentially consists of two strategies: preventing hypoxia to the corpora cavernosa and thereby reducing cavernous fibrosis, in the absence of spontaneous erections throughout the period of neurapraxia, and attempting to maintain smooth muscle integrity, potentially increasing the likelihood of preserving erectile function. Although there is currently no consensus on a single optimal protocol, vacuum device rehabilitation is widely applied in clinical practice. The daily use of the VED with progressive erection and detumescence action is generally recommended.