Team lead my Mathew C. Raynor of the Department of Urology, Vanderbilt University Medical Center, Nashville, Tenessee, USA, used epigastric vessel for reanastomosis (joining of blood vessels) in penis. They used robot to get the epigastric artery. The entire procedure required 3 cm incision, which is better alternative to large midline incision. There work on five patients who had severe pelvic (hip bone) trauma following accident was published in the Journal of Sexual Medicine yesterday September 25, 2009. This article is quoted below verbatim.

From
Journal of Sexual Medicine
Early View (Articles online in advance of print)
Published Online: 25 Sep 2009

© 2009 International Society for Sexual Medicine

Robot-Assisted Vessel Harvesting for Penile Revascularization

Mathew C. Raynor, MD,* Rodney Davis, MD, † and Wayne J.G. Hellstrom, MD, FACS*
*Department of Urology, Tulane Health Sciences Center, New Orleans, Louisiana, USA; † Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Correspondence to Wayne J.G. Hellstrom, MS, FRCS, Chief, Section of Andrology, Tulane University Health Sciences Center, Department of Urology, 1430 Tulane Avenue, SL-42, New Orleans, LA 70112, USA. Tel: (504) 988-5372; Fax: 504-988-5059; E-mail: whellst@tulane.edu
Copyright © 2009 International Society for Sexual Medicine

KEYWORDS

Erectile Dysfunction • Trauma • Arteriography

ABSTRACT

Introduction. Ideal candidates for penile revascularization include young patients with documented vasculogenic erectile dysfunction usually resulting from pelvic trauma. Historically, large midline incisions were necessary to harvest the epigastric vessels for penile revascularization. We report our experience with robot-assisted epigastric vessel harvesting for use in penile revascularization procedures.

Aim.

To describe our technique and experience with robot-assisted vessel harvesting for use in penile revascularization.

Methods.

Five patients were selected for penile revascularization. Each patient suffered pelvic crush injuries resulting in post-traumatic erectile dysfunction. Each patient had no significant prior medical history and had normal erectile function prior to injury. Penile duplex Doppler ultrasound studies using vasoactive agents demonstrated decreased arterial inflow. Complementary pelvic angiography documented the corresponding arterial lesions. Each patient underwent attempted penile revascularization using a modified Virag-V technique.

The epigastric artery was harvested robotically and transposed through a 3 cm incision at the base of the penis. Microscopic revascularization was performed by anastamosing the epigastric artery to the deep dorsal vein. Distal dorsal vein ligation of the subcoronal plexus was performed to limit glans hyperemia.

Main Outcome Measures.

Description of a new method of vessel harvesting for penile revascularization.

Results.

Penile revascularization was successful in four out of five patients. One patient had complete thrombosis of the deep dorsal penile vein and underwent subsequent penile prosthesis implantation. Each patient undergoing successful revascularization was discharged home two days postoperatively and has reported resumption of sexual activity.

Conclusions.

The robot-assisted approach to epigastric vessel harvesting is an ideal minimally-invasive complement to penile revascularization. This procedure negates the need for a large midline incision and may shorten recovery time. Our described technique offers a novel option for the application of minimally-invasive technology, but longer-term follow-up is needed to further evaluate the success of penile revascularization. Raynor MC, Davis R, and Hellstrom WJG. Robot-assisted vessel harvesting for penile revascularization. J Sex Med **;**:**–**.

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1743-6109.2009.01462.x About DOI

Download
Prescription Information on Caverject (c)

Self Injection to get Erection Satisfactory for Sexual Intercourse

• Who can use Caverject Injection?
• Who cannot use Caverject Injection?
• What is Caverject Injection?
• How to use Caverject Injection?
• How not to use Caverject Injection?
• What does Caverject Injection look like?
• What are the side effects of Caverject Injection?
• What precautions should be taken when using Caverject Injection?
• What Adverse Effect of Caverject Injection need URGENT medical treatment?
• How does Oral PGE5 Inhibitors like Viagra (c) [Sildenafil Citrate] compare with Caverject Injection? Which is the better and Why?
• References

What is Caverject Injection?

Manufactured and Marketed by Pfizer
CAVERJECT IMPULSE (c) is brand name of Injection in the Penis (Intracavernosal Use) of Alprostadil.
CAVERJECT Dual Chamber System contains alprostadil as the naturally occurring form of prostaglandin E1 (PGE1)

Caverject Alprostadil Injection for Erection Satisfactory for Sexual Intercourse

How to use Caverject Injection?

The site of injection is usually along the dorso-lateral aspect of the proximal
third of the penis. You must be taught by your doctor how to inject before using this drug.

What are the side effects of Caverject Injection?

The most common side effect of CAVERJECT IMPULSE is mild to moderate pain after injection. About one third of patients reported this pain but few stopped CAVERJECT IMPULSE for this reason.
Men may get a small amount of bleeding at the injection site.

What Adverse Effect of Caverject Injection need medical attention?

Call your doctor if you notice any redness, lumps, swelling, tenderness, or curving of the erect penis. Lumps or curving of the erect penis, including a condition called Peyronie”

How not to use Caverject Injection?

CAVERJECT IMPULSE should not be used more than 3 times per week. There must be at least 24 hours (1 day) between each dose. It should produce an erection in about 5 to 20 minutes that should last about 1 hour.

QUESTION

Dear Doctor,
is there any relation between erectile dysfunction and mastrubation?

REPLY

Masturbation never causes any side effects whatsoever even if a person believes he has begun early in childhood, for long time, too much.

After masturbation means friction on penis skin in a manner that increases excitement until there is orgasm and discharge of semen.

In all male, after discharge of semen there is a ‘time interval’ called the ‘refractory phase’ when even in presence of sexual excitement erection does not happen.

This is not called erectile dysfunction. Not getting erection immediately after sexual intercourse or masturbation is like taking pause to rest so that the tissues and sexual system can restart later.

Masturbation done early in life or any time is not a cause of Erectile Dysfunction.

I hope it answers your query.
Best Regards,
Dr. Ashok Koparday

QUESTION CONTINUES

Dear doctor,
thanks from your letter,I think that my problem is more psychological than physical.
For example when I am watching porno films (that I watch always when I have time, and it’s my hobby) I have a good erection.
Even I have upto 20 or 30 minutes full ererction.But when I face the real sex( which I had not more than 4 times in my life) I can’t get erection.
So please let mew know if my guess about this problem is right, or I have another problem?
And please show me the solution.

Best Regards
xxx XXX xxx

REPLY

PROBLEM SOLVED
Hi,

Your guess about the problem is accurate.

But when I face the real sex( which I had not more than 4 times in my life) I can’t get erection.

This is performance related where anticipation of possible failure can (not always) cause difficulty in erection. The severity depends upon the extent to which you are conscious about assumed possibility of not being able to do sex while you indulge in sex.

And please show me the solution.

Your solution is in your query itself.

I have a good erection. Even I have upto 20 or 30 minutes full ererction

The above sentence means your sexual apparatus is fine.

Example
You are like a student who has prepared very well for his exams, but some amount of tension remains while you actually go to give your exams. When you sit to write the answer paper everything goes smooth because you are well prepared. The surest and safest method that prepares you for sexual intercourse is masturbation. Be confident because you have direct evidence of good erection in your own hand.
Please let me know if you have any additional questions or issues.
Best regards,
Dr. Ashok Koparday MBBS FCSEPI

Question

about Ayurvedic Medicine and its benefit in giving stronger hard on.

On Tue, Jan 13, 2009 at 12:58 AM,

xxx wrote:
Sir,i’m 25y.o and have noticed that i dont get hard erection and doesnt last long..

Will shilajit gold capsules help to get hard erection??

Reply

Shilajeet is an ayurvedic formulation
Chronic use of Shilajeet has been found to damage kidneys.
Moreover shilajeet does not increase erection.
” _ _ _shilajit gold capsules _ _”This product available at chemist [1] has other ingredients too.

Important Info About

Ayurvedic Medicine

1

Ayurveda Medicines Have Side Effects

It is a very, very common misconception that Ayurvedic Medicines do not have side effects. Ayurveda Medicines/Ayurvedic treatment has side effects. The students and teachers of Ayurveda attest. Even ‘Meditation’, a form of alternate therapy, can have side effects.

Thumb rule: Medicine that has effect has side effect.

2

It Ayurvedic medicines did not have side effects, were totally safe, why do students study and what do they study for doing BAMS [2] in Ayurveda [3] study for 4 and 1/2 years to get registration and qualification from authorized University?.
To clarify, BAMS is Medical doctor‘s  [4] Graduation in Ayurveda. There is post graduation like MD in Ayurved also.
They are considered qualified DOCTORS who diagnose and heal patients. For Ayurveda remedies to be effective, (for any ailment):

Consult a Doctor attached to Ayurveda Institute – Ayurveda Medical College affiliated to Ayurveda Hospital

3

A

Ayurvedacharya disapprove of packing and sealing medicine and selling over the counter.
Reason:
Ayurveda is systematic body of medical science.
Ayurvedic doctor examines patients, checks the pulse, determines the balance of ‘vaat, piitaa, kaf’ in the patient at that time and makes necessary correction. Ayurvedica medicine gives details of how to make the medicine and how to take the medicine.

At G.S.Medical College, K.E.M. Hospital ayurvedic medicines have been studied the way modern medicines are studied. Ayurvedic medicine is useful when given by qualified doctor, harmful when taken without it. Panchakarma is also to be done as told by Doctor in Ayurvedic Institute.

Basically, you have not asked the question, “What is Ayurveda?. What you desire is ‘strong hard on, sexual erection’.
Perhaps you are about to get married and are concerned if you could do sexual intercourse [5] to the satisfaction of wife and yourself. If you are married you believe that wife is not satisfied because you do not have strong erection WHEN NECESSARY. Besides, you too are unhappy and know that the present erection is much less than the earlier erections.

B

To increase sale often Allopathy Medicines are sold as Ayurveda Medicines.

We have noticed, especially related to Sex Medicines, that Allopathy medicines, such as Sildenafil Citrate are packed, labeled, and sold as Ayurveda Medicines. They are often seen in Chemist’s Shop display counter, as a packet with erotic picture on it. Medicines sell because they can evade Food and Drugs Control Department approval and also because people have the FALSE BELIEF THAT AYURVED REMEDIES HAVE NO SIDE EFFECTS AND ARE ALWAYS SAFE.

4

At this point you may ask -

For my erection problem I do not want viagra drug, but I want to maintain hard erection with Ayurveda Medicines/Ayurveda treatment. Amla, Triphala, Shilajit, Aswagandha (relieves anxiety, anxiety disorder), Panchakarma (cleansing of body system by wash out body system toxins), Ayurvedic massage, many Ayurvedic herbs are words known to many a people in India.

Where to get Indian Ayurvedic Treatment?

Ayurvedic medicine is most reliable and effective for various ailments when you get it prescribed / or made by Ayurveda doctor at Ayurveda Institute. Ayurveda Institute means Ayurveda Medical College attached to Ayurveda Hospital.

5

Kindly let me know minimum these details.

• Are you still unmarried or you are married?
• What you expect as treatment outcome?
• Any dissatisfaction spoken by partner?
• What do you believe could be the cause of this problem?

The links below are specially for you
[a] http://mydoctortells.com/ tells about what details are required to get specific answer to your situation.
[b] http://mydoctortells.com/topic/men/male-sex-problems/erection-problems/
[c] http://mydoctortells.com/topic/medicine/
There are other topics, which you may find useful.
Please let me know if you have any additional questions or issues.

[a] [b] [c]

The contents of this article are original, written and reviewed by Dr. Ashok Koparday. Wikipedia is not the source of this article. No reference has been taken from the Wikipedia links below. I have not myself seen the Wikipedia pages . However, I believe they are relevant. All the links are to Wikipedia for user’s who want to study in more detail.

The links given below are for those who want to know further about this topic.

[1] chemist

[2] BAMS

[3]Ayurveda

[4] doctor

[5] Sexual Intercourse

BEST CURE FOR ERECTILE DYSFUNCTION WITHOUT MEDICINES

HONEY MOON
Nothing can replace another playful honey moon. Rather than sex as the goal, keep ‘carefree fun and outing’ as the theme of this picnic.

MIS CONCEPTIONS YOUR DANGER ZONE
Drive away the ghosts of thoughts like, “What will she think of me if I am not able to . . .?”; “Will she think that I am not a good lover if . . .?”. Remember once for all that she never measures love by the size or the erection of your penis. She is not the penis thirsty porn girl of the blue films. It is a misconception projected by the blue films. She is not thirsty of full erection and insertion, but of full romance and pure love.

THE BEST THING FOR ERECTION
The best thing for erection is a willing and cooperative partner. Cultivate romance by using the right keys of intimacy. In love making the sex mantra is more shamelessness and secrecy for her. This brings fullest erection in you.

SEX JOY THERAPY
Sensate focus therapy, non genital erotic play, or the Sex Joy Therapy of Samadhan Center of Sexual Sciences brings full erection. Sex joy therapy distills sensuous pleasure and removes the interfering brain signals thus bringing about full erection using your own power.

PERMISSION FOR SSM
Giving permission to oneself to enjoy sexually stimulating content (triple X movies, erotic stories) is part of sex therapy. It enriches ‘fantasy’ that contributes to fantastic erections.

SEX TONIC
‘Anything that is good for the body is good for sex’ is simple rule for choosing sex tonic. Thus, physical exercise becomes the top most health tonic. Pelvic floor muscle exercises are added to this.

BEST FOOD FOR IMPROVING SEX
Intake of nutritious food such as germinating pulses and grams, raw, cleaned vegetables , fresh fruits, green leafy vegetables and soy bean chunks, which is the richest source of edible proteins is beneficial to sex.

ALCOHOL
Alcohol enhances erection and sexual joy, if taken in such amount that removes inhibitions.

IMPORTANT MEDICAL FACT
Remember that if some time or the other in the last two months if you have had good erection even once, even when alone, while masturbating, or while watching blue film or just after waking from sleep (nocturnal penile tumescence) then the sexual apparatus between your legs is absolutely fit and capable of full erection. Knowing this scientific fact boosts confidence, which enables you to have powerful erections.

Dr. Ashok Koparday
_{MBBS, FC SEPI}
Medical Director
Samadhan India
Center for Therapy, Education, Research in
Sex, Marriage, Relationships

Ex. Teaching Faculty
Seth G. S. Medical College and K. E. M. Hospital and
Grant Medical College and Sir J. J. Group of Hospitals
University of Mumbai, India

best-cure-erection-problems-without-medicines