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Vacuum constriction devices for erectile dysfunction

Clinical bottom line

There is little good randomised trial data on the use of vacuum constriction devices.


References

KR Wylie et al. The potential benefit of vacuum devices augmenting psychosexual therapy for erectile dysfunction: a randomised controlled trial. Journal of Sex and Marital therapy 2003 29: 227-236.


R Raina et al. Sildenafil citrate and vacuum constriction device combination enhances sexual satisfaction in erectile dysfunction after radical prostatectomy. Urology 2005 65: 360-364.


Background

Vacuum constriction devices (VCDs) have been used for some time to increase blood flow to the penis and to achieve an erection. There is limited randomised trial evidence concerning VCDs, though there is a literature from the early-mid 1990s discussing their use, and the Raina paper contains useful references. VCDs have changed since then, and the present review looks at material from the late 1990s.

Searching

Searching was done using PubMed, Medline and the Cochrane Library, up to September 2005. Randomised trials in which VCDs were compared with any other treatments were sought. Details of the trials were abstracted and quality scoring done with a 5 point scale.

The outcome sought was patient/partner judgement of satisfactory erections suitable for intercourse, or actual intercourse, at home. Relative risk and NNT were calculated using standard methods.

Results

Only two randomised trials were found, both small, and both open studies.

In the Wylie study 370 patients attending a specialist psychosexual service with psychogenic or combined aetiology for their ED had treatment choices including medication, intracavernosal injections, vacuum devices or psychotherapy. The couple psychotherapy option was chosen by 45 (12%).

Therapy was a package of relationship therapy and modified Masters and Johnson sex therapy, lasting 45 minutes occurring every two weeks, and modified for each couple. Half the men were randomly offered the concurrent use of a VCD (Rapport SM2000). The primary outcome was the sex therapists assessment of response to treatment.

Of 25 randomised to VCD, 20 actually used it. Of these, 21 had moderate or good improvement (84%). Of 20 randomised to control, 12 (60%) had the same response. Few men chose to continue with the VCD, and most subsequently chose, and benefited from, medical therapy.

The Raina study reports on 109 men randomised to VCD or not after radical prostatectomy for nine months. Of 74 men randomised to VCD (53 with nerve sparing surgery), 60 actually used it, with constriction bands for intercourse, with a frequency of vaginal intercourse of twice per week. Of these 60, 10 reported a return of natural erections at a mean interval of nine months.

Thirty-one men were unsatisfied, and were instructed to take sildenafil 100 mg 1-2 hours before use of the device, and these men had additional benefits.

Comment

There are few randomised trials of VCDs, though a number of case series have been reported. It is clearly successful for some men, but how it compared with medical therapy for particular causes of erectile dysfunction is uncertain.