To assess the efficacy of vacuum constriction devices (VCD) following radical prostatectomy (RP) and determine whether early use of VCD facilitates early sexual activity and potentially earlier return of erectile function. This prospective study consisted of 109 patients who underwent nervesparing (NS) or non-nerve-sparing (NNS) RP between August 1999 and October 2001 and developed erectile dysfunction following surgery. The patients were randomized to VCD use daily for 9 months (Group 1, N ¼ 74) or observation without any erectogenic treatment (Group 2, N ¼ 35). Treatment efficacy was analyzed by responses to the Sexual Health Inventory of Men (SHIM) (abridged 5-item International Index of Erectile Function (IIEF-5)), which were stratified by the NS status. Patient outcome regarding compliance, change in penile length, return of natural erection, and ability for vaginal intercourse were also assessed. The mean patient age was 58.2 years, and the minimum follow-up was 9 months. Use of VCD began at an average of 3.9 weeks after RP. In Group 1, 80% (60/ 74) successfully used their VCD with a constriction ring for vaginal intercourse at a frequency of twice/week with an overall spousal satisfaction rate of 55% (33/60). In all, 19 of these 60 patients (32%) reported return of natural erections at 9 months, with 10/60 (17%) having erections sufficient for vaginal intercourse. The abridged IIEF-5 score significantly increased after VCD use in both the NS and NNS groups. After a mean use of 3 months, 14/74 (18%) discontinued treatment. In Group 2, 37% (13/35) of patients regained spontaneous erections at a minimum follow-up of 9 months after surgery. However, only four of these patients (29%) had erections sufficient for successful vaginal intercourse and rest of patients (71%) sought adjuvant treatment. Of the 60 successful users, 14 (23%) reported a decrease in penile length and circumference at 9 months (range, 4-8 months) compared to 12/14 (85%) among the nonresponders. However, in control group 22/35 reported decrease in penile length and circumference. Early use of VCD following RP facilitates early sexual intercourse, early patient/spousal sexual satisfaction, and potentially an earlier return of natural erections sufficient for vaginal penetration.

Baseline and follow-up data from 102 patients using intracorporeal (IC) injection for erectile dysfunction (ED) following RP were retrospectively collected. We compared baseline International Index for Erectile Function (IIEF) questionnaires with the abridged IIEF-5 questionnaires, referred to as the Sexual Health Inventory of Men (SHIM) to determine drug efficacy. The mean presurgery SHIM score was 21.75 7 5.23, which decreased to 4.23 7 3.48 after surgery and increased to 19.46 7 8.78 post-treatment. Overall, 68% (69/102) of patients achieved and maintained erections sufficient for sexual intercourse and 48% (49/102) of patients continued long-term therapy with a mean use of 3.7 7 1.9 y. In all, 52% (53/102) patients discontinued IC therapy. However when excluding patients who switched to oral therapy, had loss of partner or return of normal erections; the compliance to IC injections was 70.6% (71/102). There was no difference in the SHIM analysis between the nerve sparing (NS) and the non-NS or between the types of medications used. IC injections can provide excellent long-term efficacy and compliance in up to 70% of the patients. This study suggests that IC injections are an excellent salvage option in NS patients who fail oral therapy and a first option in patients with non-NS procedures.

Baseline and follow-up data of 54 patients from a single surgical series (1998)(1999)(2000)(2001), who used medicated urethral system for erection (MUSE) for the erectile dysfunction (ED) associated with radical prostatectomy (RP), were obtained. Patients were surveyed using the abridged five-item version of the International Index of Erectile Function (IIEF) questionnaire, commonly referred to as the Sexual Health Inventory of Men (SHIM), to determine presence and severity of ED and efficacy of ED treatment modalities. The mean patient age was 63.775.6 y and the mean follow-up period was 2.371.2 y. All patients experienced ED for at least 6 months after their surgery before starting MUSE therapy. Overall, 55% of the patients achieved and maintained erections sufficient for sexual intercourse while on MUSE and 48% continued long-term therapy with a mean use of 2.3271.2 y. The mean presurgery SHIM score in these patients was 19.271.3, which decreased to 5.270.5 after surgery and increased to 16.371.3 after MUSE treatment. A total of 28 patients (52%) discontinued treatment after a mean use of 871.4 months. The reasons for discontinuation were insufficient erections (n ¼ 16, mean SHIM score of 10.574.4), switch to other ED therapies (n ¼ 4), natural return of erections (n ¼ 4) and urethral pain and burning (n ¼ 4). Excluding the patients (n ¼ 8) who preferred other therapies and return of natural erections, the compliance to MUSE was 63%. There were no significant differences in the IIEF-5 responses between the patients who had a nervesparing technique (n ¼ 34) and those who did not (n ¼ 20) or among patients who used different doses (250, 500 or 1000 lg) of MUSE. The results of the current trial indicate that MUSE is a successful treatment option in RP patients with established ED. It appears that a post-treatment SHIM score of Z16 defines a successful outcome with MUSE therapy.

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Aim Fear of pain with intracavernosal injection (ICI) therapy may discourage its use in patients with erectile dysfunction (ED). Methods We prospectively analyzed patient self-report of discomfort with ICI therapy for ED utilizing a visual analog scale from 0 to 10. Results Patient self-report using a visual analog scale revealed minimal discomfort, with 59 consecutive patients reporting an average pain score of 1.93 ± 1.76. There was no statistical difference between self-administered or nurse-administered injections. The volume of the injection also had no statistical effect on pain score, and there was no difference observed between those who received alprostadil alone or combination treatment. Patients with diabetes mellitus did have significantly higher pain scores than other patients (3.31 ± 2.25 vs. 1.62 ± 1.39, P = 0.009), even when controlling for other factors. Conclusion Clinicians should be aware of the greater potential for discomfort in ED patients with diabetes. In the majority of ED patients, however, discomfort is minimal, and this information should be helpful in alleviating fear of injection in those who may benefit from this therapy.