Abstract | Symptomatic Erectile dysfunction | Table 1 | Results for Table 1 | Regular Use
Quality of Erections | Side effects | Satisfaction | PPPI comment

Of our patients treated with prior injection therapy there was no statistically significant difference in satisfaction or regular use. The success rate of Gilbert and Gingell was also low when compared with results of other studies of patients who failed to achieve success with injection therapy before vacuum constriction device use. Marmar et al reported results in 22 patients who received intracavernous injections but who failed to achieve a complete erection. They found that 21 of the 22 patients achieved a rigid erection with the vacuum constriction device after only partial tumescence with injection therapy alone. Allen et al found a 94% positive predictive value of a good response to papaverine in selecting patients in whom a vacuum device would be successful. They reported only a 46% initial response with rigidity satisfactory for intercourse in patients using the vacuum constriction device but this was improved to 88% with regular use. Thus, it appears that satisfaction and successful use of the vacuum constriction device can be expected from patients with a history of pharmacological intracavernosal injection therapy, including those who have failed with this form of treatment.

In addition to prior therapy with a pharmacological erection program, vacuum constriction devices have proved successful in patients who failed prior penile prosthesis. Our study included 4 patients who underwent explanation of a failed penile prosthesis, and all reported satisfactory erections and regular use of the vacuum constriction device. This finding is in support of the study by Moul and McLeod who reported a 71% (10 of 14) rate of regular use and 73% rate of patient and partner satisfaction among patients in whom a penile implant had been removed before vacuum constriction device use.

They noted that the quality of erection and satisfaction improved with time, possibly due to the resolution of corporeal scarring and progressively improved blood flow into corporeal sinuses.
Satisfaction in terms of hardness, length and circumference was greater than 90% in both groups. The fact that there was no significant change in satisfaction with hardness and length between the 2 groups indicates that rigidity achieved at 3 months is a reproducible phenomenon, which as durable through 29 months of average use.

Perhaps the most interesting finding was in satisfaction (greater than 90%) with regard to penile circumference. This finding is surprising because the vacuum constriction device produces a penile diameter greater than that attained during a normal erection with blood trapped in the extracorpoeal tissues accounting for these differences.

Few reports on vacuum constriction device use contain information addressing partner satisfaction. Responses from both groups indicated greater than 85% partner satisfaction during intercourse while using the device. Turner et al reported an increase in partner arousal, ability to achieve orgasm during inter course and overall greater partner satisfaction.

Our patients were also asked whether the partner had noted any "coldness" of the penis during intercourse.
Although "coldness" was noted by about a quarter of partners in both groups, that which decreased partner pleasure was experienced by only approximately 10% in both groups.

Nadig et al have previously described a skin temperature change of the penis to decrease gradually an average of 0.96C (0.5 to 3.1C) in 30 minutes. This decrease is due to venous pooling of blood and a partial arterial obstruction created by the vacuum constriction device at the base of the penis. This finding has been confirmed by Marmar et al who demonstrated a 70 to 75% decrease in the penile brachial artery index using penile plethysmography during application of the vacuum constriction device ring. Interestingly, the majority of patients in both groups stated that this was not a problem.

Vacuum constriction devices have proved to be an effective way to produce an erection-like state in patients with erectile dysfunction. Although early success and satisfaction have been previously reported, few studies address the long-term results in device use. Our study supports the concept that excellent results in patient and partner satisfaction as well as early regular use can be expected to continue with time.

Finally, we have demonstrated a statistically significant increase in the frequency of successful intercourse attempts in 79% of the patients using the device for 1 year, which was maintained in 77% beyond the first year.

Despite its limitations, the vacuum constriction device appears to be an effective and durable non-operative treatment for erectile dysfunction, and its use should continue to increase along with its growing patient population.