Vacuum therapy in erectile dysfunction—science and clinical evidence

Yuan, Jiuhong; Hoang, Anthony N.; Romero, Claudio; Lin, Haocheng; Dai, Yutian; Wang, Run

doi:10.1038/ijir.2010.4

Cited by 87 publications

(57 citation statements)

References 98 publications

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“…In a study of men aged 55-75 years, more frequent coitus was associated with about a 50% reduction of ED, although establishing cause and effect would require a randomized study. 18 'Penile rehabilitation' is increasingly used to preserve erectile function following radical prostatectomy, using either a vacuum device 19 or PDE-5 inhibitors. 20 In a randomized, crossover study, pelvic floor exercises also reduced ED, most likely by reducing venous outflow from the penis.…”

Section: Exercisementioning

confidence: 99%

Lifestyle and metabolic approaches to maximizing erectile and vascular health

et al. 2011

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Oxidative stress and inflammation, which disrupt nitric oxide (NO) production directly or by causing resistance to insulin, are central determinants of vascular diseases including ED. Decreased vascular NO has been linked to abdominal obesity, smoking and high intakes of fat and sugar, which all cause oxidative stress. Men with ED have decreased vascular NO and circulating and cellular antioxidants. Oxidative stress and inflammatory markers are increased in men with ED, and all increase with age. Exercise increases vascular NO, and more frequent erections are correlated with decreased ED, both in part due to stimulation of endothelial NO production by shear stress. Exercise and weight loss increase insulin sensitivity and endothelial NO production. Potent antioxidants or high doses of weaker antioxidants increase vascular NO and improve vascular and erectile function. Antioxidants may be particularly important in men with ED who smoke, are obese or have diabetes. Omega-3 fatty acids reduce inflammatory markers, decrease cardiac death and increase endothelial NO production, and are therefore critical for men with ED who are under age 60 years, and/or have diabetes, hypertension or coronary artery disease, who are at increased risk of serious or even fatal cardiac events. Phosphodiesterase inhibitors have recently been shown to improve antioxidant status and NO production and allow more frequent and sustained penile exercise. Some angiotensin II receptor blockers decrease oxidative stress and improve vascular and erectile function and are therefore preferred choices for lowering blood pressure in men with ED. Lifestyle modifications, including physical and penile-specific exercise, weight loss, omega-3 and folic acid supplements, reduced intakes of fat and sugar, and improved antioxidant status through diet and/or supplements should be integrated into any comprehensive approach to maximizing erectile function, resulting in greater overall success and patient satisfaction, as well as improved vascular health and longevity.

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Section: Exercisementioning

confidence: 99%

Lifestyle and metabolic approaches to maximizing erectile and vascular health

et al. 2011

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“…4 It is considered a second-line treatment for patients where PDE5Is are either contraindicated or ineffective. The VED is also very useful in the subset of men with prostate cancer who have undergone radical prostatectomy or pelvic radiation therapy.…”

Section: Pde5i Plus Vedmentioning

confidence: 99%

Combination therapy for erectile dysfunction: an update review

Dhir¹,

Lin

Canfield³

et al. 2011

Asian J Androl

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The introduction of oral phosphodiesterase-5 inhibitors (PDE5Is) in the late 1990s and early 2000s revolutionized the field of sexual medicine and PDE5Is are currently first-line monotherapy for erectile dysfunction (ED). However, a significant proportion of patients with complex ED will be therapeutic non-responders to PDE5I monotherapy. Combination therapy has recently been adopted for more refractory cases of ED, but a critical evaluation of current combination therapies is lacking. A thorough PubMed and Cochrane Library search was conducted focusing on the effectiveness of combination therapies for ED in therapeutic non-responders to PDE5I therapy. Journal articles spanning the time period between January 1990 and December 2010 were reviewed. Criteria included all pertinent review articles, randomized controlled trials, cohort studies and retrospective analyses. References from retrieved articles were also manually scanned for additional relevant publications. Published combination therapies include PDE5I plus vacuum erectile device (VED), intraurethral medication, intracavernosal injection (ICI), androgen supplement, a-blocker or miscellaneous combinations. Based on this review, some of these combination treatments appeared to be quite effective in preliminary testing. Caution must be advised, however, as the majority of combination therapy articles in the last decade have numerous limitations including study biases and small subject size. Regardless of limitations, present combination therapy research provides a solid foundation for future studies in complex ED management. 1 Current projections indicate an increase in the prevalence of ED due to aging as well as the continued abundance of comorbidities such as coronary artery disease, hypertension and diabetes in industrialized nations. Over 320 million people in Westernized nations will be affected by 2025, more than double the prevalence seen 15 years ago, indicating a growing need to reevaluate ED therapeutic strategies.2 Over the past four decades, the treatment of ED has evolved rapidly and is still changing with new discovery. Before the 1970s, psychotherapy was the primary means of treatment and undoubtedly was limited in its success. During the 1970s, penile prostheses combined with psychotherapy remained popular but relatively inaccessible. The 1980s was dominated by intracavernous injection (ICI) and followed by intraurethral therapy in the mid-1990s. Despite this transition towards non-surgical management, available treatment modalities were not patient-friendly. The introduction of oral phosphodiesterase-5 inhibitors (PDE5Is) in the late 1990s and early 2000s revolutionized the field of sexual medicine and PDE5Is are currently first-line monotherapy.

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“…The question of whether suberectile IUA would provide adequate cavernous oxygenation was addressed in penile oximetry studies. In one series comparing the effects of IUA, a vacuum erection device (VED), and ICI, the group noted that 250 μg IUA was equivalent to an erectogenic ICI dose [McCullough et al 2010;Yuan et al 2010]. They also noted that a nightly dose of 250 μg IUA resulted in improved cavernous oximetry the next day [McCullough et al 2010].…”

Section: Intracorporeal Injection Therapymentioning

confidence: 99%

“…Depending on its purpose, VT could be used as a vacuum constriction device (VCD), with the aid of an external constricting ring which is placed at the base of penis to prevent blood outflow, maintaining the erection for sexual intercourse. Also, a vacuum erectile device (VED), without the application of a constriction ring, just increases blood oxygenation to the corpora cavernosa and for other purposes [Yuan et al 2010].…”

Section: Vacuum Erection Devicesmentioning

confidence: 99%

Optimizing postoperative sexual function after radical prostatectomy

Tutolo

Briganti

Suardi

et al. 2012

Therapeutic Advances in Urology

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Erectile dysfunction (ED) is one of the complications associated with pelvic surgery. The significance of ED as a complication following pelvic surgery, especially radical prostatectomy (RP), lies in the negative impact that it has on patients' sexual and overall life. In the literature, rates of ED following RP range from 25% to 100%. Such variety is associated with pelvic dissection and conservation of neurovascular structures. Another important factor impacting on postoperative ED is the preoperative erectile function of the patient. Advances in the knowledge of pelvic anatomy and pathological mechanisms led to a refinement of pelvic surgical techniques, with attention to the main structures that if damaged compromise erectile function. These improvements resulted in lower postoperative ED rates and better erectile recovery, especially in patients undergoing RP. Furthermore, surgery alone is not sufficient to prevent this complication, and thus, several medical strategies have been tested with the aim of maximizing erectile function recovery. Indeed it seems that prevention of postoperative ED must be addressed by a multimodal approach. The aim of this review is to give a picture of recent knowledge, novel techniques and therapeutic approaches in order to reach the best combination of treatments to reduce the rate of ED after pelvic surgery.

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Vacuum therapy in erectile dysfunction—science and clinical evidence

Cited by 87 publications

References 98 publications

Lifestyle and metabolic approaches to maximizing erectile and vascular health

Lifestyle and metabolic approaches to maximizing erectile and vascular health

Combination therapy for erectile dysfunction: an update review

Optimizing postoperative sexual function after radical prostatectomy

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