Indications for Treatment of Erectile Dysfunction with VCD

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Compared to other therapeutic options for ED the major advantage of VCD is that it can be applied successfully for nearly all etiologies of ED [2]; but its success clearly depends on adequate instruction [3].

After the launch of the phosphodiesterase type 5 inhibitors, the first effective oral treatment for broad spectrum ED populations, VCD became a second-line therapy along with intracavernosal self-injection and intraurethral therapy with vasoactive substances [4]. VCD may be offered mainly to elderly patients with occasional intercourse attempts, as younger patients show limited acceptance because of its mechanism resulting in a more unnaturally perceived erection [5]. On the other hand there may be couples preferring VCD, as was reported by Chen et al., with one-third of men, who had been successfully treated with VCD and who had tried sildenafil with satisfactory erections, finally opting for VCD [6].

Vacuum therapy may also be used in conjunction with other therapies to enhance results. So, for example, the addition of 100 mg sildenafil with VCD improved sexual satisfaction and penile rigidity in patients unsatisfied with VCD alone, after radical prostatectomy [7]. Combination treatment of psychotherapy and VCD showed greater beneficial response in men with ED than either therapy alone [8].

Nearly all commercially available vacuum devices share a common mechanism of action: a plastic cylinder, whose lower edge is made airtight with the application of a lubricant gel, is applied over the penis in a standing position and then firmly pressed against the body (see Fig.11.1a). Then a vacuum is created manually via a pump that is either separately connected to the cylinder with a tube or is directly integrated in the distal end (top) of the cylinder and is then battery operated (see Figs 11.1a, 11.1b). The erection obtained with VCD is not a natural-like erection. The vacuum pressure passively draws blood into the sinusoidal spaces of the cavernous bodies of the penis, whose diameters double after negative pressure distension, but with maintenance of the

European Sexual Dysfunction

Fig. 11.1 Technique of vacuum device therapy (the conventional "two-piece" Osbon Erec-Aid® system).

Fig. 11.1 Technique of vacuum device therapy (the conventional "two-piece" Osbon Erec-Aid® system).

cavernous artery flow [9]. Once an adequately rigid erection has been achieved a rubber constriction ring, previously rolled onto the cylinder prior to the vacuum maneuver, is now rolled off the base of the penis preventing the escape of the artificially entrapped blood. The application of the constriction ring should be limited for up to 30 minutes to avoid ischemic damages of the cavernosal tissue. Sometimes two constriction rings must be applied to maintain a rigid erection. Vacuum pressures between 100 mm Hg and 225 mm Hg is necessary to achieve erection [10]. Compared to naturally occurring erections, VCD -derived erections are perceived differently by both the men and their partners. Because the constriction ring can b e applied only to the base of the penis, the proximal third of the cavernous bodies, i.e. the crura, are not involved in VCD erections. This non-involvement of the crura penis in VCD-induced erection causes some degree of instability at the penis' base, quite often requiring manual assistance while inserting the penis into the vagina. Due to the passively entrapped venous blood, the VCD-erected penis looks more cyanotic, is perceived to be much cooler, and not always enjoyed by the partners, in addition to the increased glans volume [11].

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Dealing With Erectile Dysfunction

Dealing With Erectile Dysfunction

Whether you call it erectile dysfunction, ED, impotence, or any number of slang terms, erection problems are something many men have to face during the course of their lifetimes.

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