Who is a candidate for the vacuum device?
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Most men may use the vacuum device, and there are relatively few contraindications to its use. Men who have bleeding problems or who are taking blood thinners can use the vacuum device but must be careful. Men with Peyronie's disease who have significant penile curvature may not be able to use the device because the erect penis may not fit in the cylinder. In such cases, corrective surgery to straighten the penis may be performed before the use of the vacuum device, or the man can try using the device and generating a less rigid erection. An uncooperative partner precludes the successful use of the device.
What are the success and satisfaction rates for the vacuum device?
The initial report on the vacuum device, which was published in 1985, reported a 90% success rate for this device in achieving an erection that was adequate for sexual performance. Since then, published success rates with the vacuum device have ranged from 84-95%, and overall satisfaction rates reported for this device have ranged from 72-94%. Notably, the vacuum device has been shown to be effective in treating men with erectile dysfunction of many different causes. In patients with spinal cord injuries, the success rate is reported to be 92%. In those with psychogenic erectile dysfunction, this device also yields good results. In men who have erectile dysfunction caused by arterial disease or after radical prostatectomy, the success rate ranges from 90-100%. Furthermore, the vacuum device is successful in some men who were impotent after the removal of a penile prosthesis.
Approximately 50-70% of individuals continue to use the vacuum device over the long term. Reasons for discontinuation of this therapy include issues unrelated to the device (e.g., return of spontaneous erections, loss of libido, or loss of partner), which were cited in 43% of cases in one study. In 57% of cases, the reason for discontinuation is related to side effects of the device or partner dissatisfaction.
Several studies have compared the vacuum device with other forms of treatment for ED. In a study of men who were using the vacuum device successfully and then tried sildenafil (Viagra), approximately one-third preferred to resume use of the vacuum device rather than continue with the oral medication, citing the fact that the vacuum device gave them a better-quality erection. In a study that compared intracavernosal therapy (injection therapy) with the vacuum device, there was a trend among younger patients who had a shorter period of ED to favor intracavernosal therapy.
What are the side effects of the vacuum device?
Side effects of the vacuum device include the following:
• Penile coolness. With the vacuum device, penile skin temperature may decrease by 18°C.
• Penile skin cyanosis. Congestion outside the corpora may make the penile skin look blue. This problem resolves with removal of the constricting band.
• Increased girth. The penile width after use of the vacuum device is actually wider than is seen with a normal erection.
• Pain. The most common complaint, pain usually occurs when men first use the device. It may be related to either the vacuum or the constricting band. Discomfort during suction is noted in 20-40% of men who use the vacuum device, primarily in men who are just learning to use the device. The pain appears to decrease with continued use of the vacuum device and may be related to initial unfamiliarity with the device. As many as 45% of men have pain at the site of the constricting band. Again, this discomfort seems to improve with time and familiarity with the device.
• Ejaculatory troubles. Pain with ejaculation is reported by 3-15% of men who use the vacuum device, and inability to ejaculate occurs in 12-30%.
• Penile bruising. This side effect is noted in 6-20% of men who use the vacuum device.
• Numbness during erection. This side effect occurs in 5% of men who use the vacuum device.
• Partner dissatisfaction. This rate ranges from 6-11%, with the following reasons for dissatisfaction being cited: unhappy with the performance, penile temperature, and penile appearance.
Severe complications (serious, undesired results of a treatment) are uncommon with use of the vacuum device, but they can occur. In particular, ischemia (decreased blood flow) of the penis leading to necrosis can occur if the constricting band is left on too long. This complication is more of a problem in men with spinal cord injuries because they do not feel the discomfort related to the band. If the band is removed within 30 minutes of application, the risk of penile ischemia is rare.