Vacuum Therapy in Erectile Dysfunction—Science and Clinical Evidence

J Yuan; A N Hoang; C A Romero; H Lin; Y Dai; R Wang

Disclosures

Int J Impot Res. 2010;22(4):211–219 

In This Article

VT in Erectile Dysfunction–VCD

Indications

VCD therapy can be applied successfully for nearly all etiologies of ED;[8] although its success depends on appropriate instruction and practice.[19] More than 90% of men will experience functional erection with VCD therapy with adequate practice.[9]

It is currently a second-line therapy along with intracavernosal self-injection and intraurethral therapy with vasoactive substances.[20] It is widely believed that VCD therapy is more acceptable among elderly patients with occasional sexual intimacy, as younger patients may show limited acceptance because of its perceived 'unnatural' erection.[21] Chen et al., conversely, reported that VCD therapy remained the preferred treatment option among couples who had achieved satisfactory erections with either VCDs and PDE5I.[22]

VCD may also be used in conjunction with other therapies for synergistic effects. It has been reported that VCD therapy could be combined with PDE5I,[23] intracavernosal self-injection,[24,25] intraurethral therapy,[26] psychotherapy[27] and even penile prosthesis.[28,29]

Contraindications

Contraindications to the use of VCD are few and primarily include patients with a tendency for spontaneous priapism or intermittent prolonged erections, and those with severe penile anomalies (either congenital or acquired).[7] There are some relative contraindications, which can be overcome by education and precautious care, such as cultural taboo, cervical or high-thoracic spinal cord injuries, neurological disease or degenerative joint diseases with poor manual dexterity.[30] Patients with bleeding disorders or those on anticoagulation therapy are considered at high risk to develop petechiae, eechymosis or hematoma;[7] however, it was shown that the risk did not exceed that of the general population.[31]

Clinical Results

VCDs, unlike PDE5Is, have not had to undergo strict clinical trials to show their safety and efficacy before their widespread usage. A review of literature consists largely of single-center observational series, collection of small prospective clinical trials and commercial databases. Despite the paucity of data, a wealth of clinical experience is available, although with big variability in the clinical efficacy of VCD therapy. These data are present in Table 1.

Nadig et al. were the first to provide objective data regarding penile rigidity obtained using VCDs. It was found that buckle pressures of 454 g (the minimal criterion for rigidity used by many sleep laboratories) were achieved in 27/35 (77%) patients.[8] Bosshardt and co-workers showed that a nocturnal penile tumescence rigidity of 80% (70% being sufficient for intercourse)[40] was the norm after 6 months in their group of 26 patients. They also showed that induced ischemia could result after 30 min of applying the constriction rings. This led to the recommendation that the constriction ring should not be left on for >30 min to prevent ischemic injury to the penis.[18]

The effectiveness of VED has been established for different causes of ED. For those with arteriogenic ED, VCD therapy achieved the efficacy and satisfaction rates of 67 and 84%, respectively.[37] For the corporeal veno-occlusive dysfunction ED, Kolettis et al.[38] reported a 56% satisfaction rate. For diabetic ED, Arauz-Pacheco et al.[41] and Bodansky et al.[42] reported successful rates of 75 and 58%, respectively. No severe side effects were reported. For spinal cord injury-induced ED, an impressive 85% successful rate was achieved with minor side effects.[43] The largest patient group (34 777 cases) was reported by Lewis and Witherington[7] who used the VCD data from Osbon data bank with satisfaction rates 65–83%; however, only 17% (5847) cases had enough information to evaluate. Conversely, Vrijhof et al.[36] and Sidi et al.[16] reported much lower satisfaction rates, 50 and 68%, respectively. More dramatically, Dutta et al. reported only 35% satisfaction rate, with an attrition rate of 65%.[39] It is believed that the huge discrepancy of satisfaction rates may be attributed to patient selection and patient education.

Complications

The use of VCD is usually well tolerated with mostly mild side effects (Table 2). The most common side effects include numbness, pain, penile bruising or petechiae.[9,32,37,44–46] Due to the constriction rings, painful ejaculation or sensation of trapped ejaculate has also been commonly reported.[7,9] Other rare complications such as leg spasms, testicular migration, urethral varicosities/bleeding have been reported.[47] Major complications like Peyronie's disease, penile skin necrosis, penile gangrene and Fournier's syndrome have been reported anecdotally.[47–52]

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