Vacuum Constriction Device: Data From Nih Seer Program

Until Nadig published his results on its efficacy, VCD was relatively unknown to the urological community. In his original study, more than 90% of patients (32/35) achieved firm erections sufficient for vaginal penetration. This was followed by a long-term study published in 1993 that reported excellent, durable results of patient’s satisfaction and quality of erections greater than 90%. Since then, many studies have demonstrated that VCD therapy is an effective noninvasive treatment alternative for ED. However, many of these studies were done in the mid-1990s when the role of VCD was still being defined.

Following the Nadig study, Segenreich et al. published similar results in which 150 enrollees were followed on an average of 25 months. Out of 150 enrollees, more than 75% achieved adequate erections; however, only 72 patients purchased the device. Satisfaction rate among these patients was more than 90%. Baltaci also achieved comparable results in which 67 enrollees were followed over a 12-month period. Of the 61 participants, 49 purchased the device and used it regularly. Among these participants, the efficacy and satisfaction rates were 67% and 84%, respectively.

Nevertheless, roughly one third of the participants were unable to achieve or maintain erection with the device.

One important point ascertained clearly in this study was that those with proven arteriogenic impotence also benefited from using the device. In addition, Kolettis et al. demonstrated that VCD was a safe, acceptable alternative treatment for corporeal venoocclusive dysfunction as well.

While some displayed compelling satisfaction and success rates, others revealed less than convincing results. Vrijhof et al. reported that only 50% of his enrollees were able to achieve adequate erections for intercourse; meanwhile, Sidi et al., reported only 68% satis-faction rate with the therapy. Dutta et al., on the other hand, revealed an attrition rate of 65% and satisfaction rate of only 35%. In this study, participants were divided into three groups: mild, moderate, and severe ED. Many of those who discontinued using the device came from the mild and severe groups; however, even in the moderate group, the attrition rate was 55%. Top three reasons for discontinuation were ineffectiveness, pain, and cumbersomeness.

With the role of VCD firmly established, the focus was being shifted toward expanding its applications. Recently, this focus has been directed toward penile rehabilitation, postprostatectomy. Most trials utilized 5-PDEi to improve oxygen delivery to penile tissues seeking to preserve penile sexual health, as well as to minimize any tissue injuries that otherwise occur during the postprostatectomy period. One limitation of 5-PDEi was its requirement of intact neural connections. The direct mechanism of VCD circumvented this limitation. Raina et al. randomized 109 post nerve-sparing prostatectomy patients to either early VCD daily usage (group 1, N = 70) versus no erectogenic aid (group 2, N = 35). Australia viagra online – sildenafil citrate online store.

Participants were followed by their Sexual Health Inventory for Men (SHIM) score. Secondary endpoints included compliance, changes in penile circumference or length, return of natural erectile function, and the ability for vaginal intercourse. At the end of 9 months followup, 80% (60/74) of group 1 were able to be sexually intimate using the device. Satisfaction rate was 55%. A total of 19 patients reported the return of natural erections with 17 having erections sufficient for vaginal penetrations. On the other hand, only 37% (13/37) of patients regained their natural erections in group 2. When evaluating for secondary endpoints, among those who used the device regularly, only 23% (14/60) reported a decrease in penile length and girth, whereas 22/35 (60%) patients in the control group complained of penile shrinkage. This result was confirmed by a study from Dalkin et al., in which 39 postprostatectomy men were given VCD therapy for 90 days postcatheter removal. In their study, 97% of the compliant men maintained their preoperative stretched penile length, with shrinkage being defined as ³1 cm. The authors concluded that early usage of VCD facilitates early return of spontaneous erectile function, early resumption of sexual life resulting in spousal satisfaction, and the preservation of penile length and size.