Results of VCD therapy (Table 11.1) Among the available literature on VCD publications,

Results of VCD therapy (Table 11.1) Among the available literature on VCD publications,

most series are reporting on the outcome of the Osbon VCD devices (Osbon Erec-Aid®) and its suc- cessor (Osbon Esteem®), and only few smaller series are published with the devices of other manufactur- ers such as Innovital System, Post-T, VED, and the Synergist System.

When analyzing the data of VCD therapy a striking feature of many published series is the discrepancy between the numbers of VCD users or men to whom VCD was prescribed, respectively, and those finally being eligible for assessment. So, for example, in the large series as published by Witherington [13] and Lewis [11], only 10–17% of all VCD owners were considered or eligible, respectively, for evaluation of the outcome, which is in marked contrast to all other ED therapies such as oral therapy, self-injection therapy, or even penile implants. In these series, in which a majority of primarily recruited patients were eligible, 40–60% failed to continue with VCD therapy [18,19,21]. The generally low acceptance of VCD therapy was shown in the series of Graham et al; among 1236 new ED patients who were subject to all diagnostic work-up and to whom all therapeu- tic modalities available at that time were offered to only 323 (27%), requested a two-week trial period and only 74 (6% of the total population) finally went for a VCD prescription [20]. In a German VCD series it was obvious that the acceptance rate of VCD was markedly higher in non-responders to pharma-

(a)

(b)

Fig. 11.1 Technique of vacuum device therapy (the conventional “two-piece”

Osbon Erec-Aid® system).

Vacuum Constriction Device 123

Table 11.1 Overview of the literature on VCD therapy outcome.

Follow-up Author

Mean age

(months) Satisfaction

erections Blackard[14] 1993

61 2 weeks 23% Droupy[21] 1998

cotherapy compared to responders (45% vs. 22%) penile bruising, or petechiae, are the most common [15].

complications of VCD. Painful ejaculation, due to the constriction ring, has been commonly reported [11,13]. As mentioned, although VCD are able to

Contraindications

give sufficient penile rigidity in the majority of Contraindications in the use of vacuum therapy are

patients, vaginal penetration can be impaired few and primarily include patients with a tendency

because of the instability of the phallus at the penis for spontaneous priapisms/prolonged erections

base, and ejaculation is achieved in less than two- [11]. Originally, bleeding disorders were considered

thirds of men due to the fact that passage through the

a contraindication [11], but a prospective trial urethra is blocked by the constriction ring [11]. In showed that the adverse effects of vacuum therapy,

addition, satisfaction with sexual intercourse may be especially hematoma and petechiae, in patients on

impaired because the whole situation may not be warfarin, did not exceed those observed in the

accompanied by a subjective state of physical or general urologic population [23]. In addition VCD

mental sexual arousal. Thus, the mere physical pres- therapy is contraindicated in severe penile anom-

ence of an erection does not seem to evoke bodily or alies, especially in marked penile deviations—either

mental feelings of sexual arousal, especially in the congenital or acquired—as a consequence of

partners [24].

Peyronie’s disease. Rarely, the use of VCD has been associated with Peyronie’s disease [25]. In a prospective trial the use of VCD for spinal cord-injured men with erectile

Complications

dysfunction did not increase the risk of adverse Side effects such as occasional numbness, pain,

events [26]. Other anecdotal complications linked to

124 Chapter 11 VCD were skin necrosis and urethral bleeding [27].

shortening [30,31]. Chronic intermittent stretching Sometimes, continuous use of VCD may result

with a vacuum erection device was used in a small in hyperpigmentation of the penile skin due to

trial to lengthening shortened penises caused by repeated skin bruising, with subsequent hemo-

severe Peyronie’s disease, after venous grafting [36]. siderin deposition. It is important to advise patients

Moreover, as mentioned before, VCD may be to use only prescription devices. Others devices have

used successfully in conjunction with self-injection no pressure control or safety valves to release the

therapy, and may add to its efficacy [37,38]. pressure, which can increase the rate and severity of complications [25].