Vacuum Constriction Devices in .NET

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Vacuum Constriction Devices
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Sidney Glina and Hartmut Porst
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History
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The concept of vacuum device therapy in the treatment of erectile dysfunction (ED) goes back as early as 1874 when the American physician John King described a method of improving erections by a small vacuum pump The rst patent for a vacuum device was granted in 1914 in Germany and 1917 in US to Otto Lederer In 1960 the American entrepreneur Geddings Osbon started to produce a vacuum device and founded his own company for manufacturing the device he had invented Finally in 1982 he was granted permission from the Food and Drug Administration to produce this device, which was named Erec-Aid [1] Nadig et al published the rst report on ef cacy and safety of vacuum constriction devices (VCD) in 1986 [2]
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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 sildena l with satisfactory erections, nally 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 sildena l with VCD improved sexual satisfaction and penile rigidity in patients unsatis ed with VCD alone, after radical prostatectomy [7] Combination treatment of psychotherapy and VCD showed greater bene cial response in men with ED than either therapy alone [8]
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Technique of VCD (Fig 111a, 111b)
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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 rmly pressed against the body (see Fig111a) 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 111a, 111b) 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
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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 rst effective oral treatment for broad spectrum ED populations, VCD became a secondline therapy along with intracavernosal selfinjection 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
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Fig 111 Technique of vacuum device therapy (the conventional two-piece Osbon Erec-Aid system)
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cavernous artery ow [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 arti cially 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 be applied only to the base of the penis, the proximal third of the cavernous bodies, ie 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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Results of VCD therapy (Table 111)
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Among the available literature on VCD publications,
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most series are reporting on the outcome of the Osbon VCD devices (Osbon Erec-Aid ) and its successor (Osbon Esteem ), and only few smaller series are published with the devices of other manufacturers 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 nally 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 therapeutic 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) nally 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-
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