What procedures or devices are used for erectile dysfunction

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Vacuum Devices
Vacuum devices, or external management systems, are effective, safe, and simple to use for all forms of impotence except when severe scarring has occurred from Peyronie’s disease. Devices include Erecaid, Catalyst, and the VED pump and are available over the counter.

Using the Device. Patients must receive thorough instructions in the proper use of such devices. They typically work as follows:

• The man places the penis inside a plastic cylinder.

• A vacuum is created, which causes blood to flow into the penis, thereby creating an erection.

• A band is tightly secured around the base of the penis, which retains the erection, and the cylinder is removed.

• It takes about three to five minutes to produce an erection.

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Lack of spontaneity is this method’s only major drawback. The erection involves only part of the penis shaft, and the process will certainly seem peculiar in the beginning. When these psychological obstacles are overcome, many couples find the result highly satisfactory.

Success Rates. Studies have found that success with the vacuum device is equal to other methods. Between 56% and 67% of men using it reported the device to be effective. In one study of men who had used the vacuum device for many years, almost 79% reported improvement in their relationships with their sexual partners, and 83.5% said they had intercourse whenever they chose. Nevertheless, drop out rates are high. In one 1999 study, for example, the overall drop out rate was 65%. Even in a high-success group, over half stopped using it.

Side Effects. Side effects include blocked ejaculation and some discomfort during pumping and from use of the band. Minor bruising may occur, although infrequently. It is very important to use a medically approved pump. There have been reports of injury from vacuum devices bought through catalogues that do not have a pressure-release valve or other safety elements.

Venous Flow Controllers
Vacuumless devices that trap blood within the penis are also available. They are called venous flow controllers or simple constricting devices. These devices are typically rubber or silicone rings or tubes (eg, Actis) that are placed at the base of the erect penis to trap the erection. They can be used by men who can achieve erections but lose them easily. These devices should not be used for longer than 30 minutes or lack of oxygen can damage the penis, and they should not be used by patients who have bleeding problems or are taking anticoagulants ("blood thinners").

Penile Implants
Three types of surgical implants are currently being used for the treatment of erectile dysfunction:

• A hydraulic implant consists of two cylinders placed within the erection chambers of the penis and a pump. The pump releases a saline solution into the chambers to cause an erection, and removes the solution to deflate the erection.

• A penile prosthesis is composed of two semi-rigid but bendable rods that are placed inside the erection chambers of the penis. The penis can then be manipulated to an erect or non-erect position.

• A third implant uses interlocking soft plastic blocks that can be inflated or deflated using a cable that passes through them.

Implant surgery is irreversible. Erectile tissue is permanently damaged when these devices are implanted. Mechanical breakdown can occur, and a less than optimal quality of erection may result. According to a 2000 study, alprostadil via the MUSE system may restore or improve the function of a penile prosthesis in patients with a failed device. In spite of concern about silicone implants in women, there have been no reports of immunologic disorders in the 20 years these implants have been used in men. Although more than 200,000 implant procedures were performed between 1982 and 1989, this is now the least popular therapy for erectile dysfunction.

Infection. Infection may be the major cause of penile implant failure. Some experts believe that almost any intermittent pain that continues to occur after an implant is due to an infection, usually low-grade. Redness and fever often accompany a full-blown infection. If the infection can be caught early enough, implant failure can be prevented. Most infections are caused by Staphylococcus, which is treated with antibiotic therapy for at least 10 to 12 weeks. If antibiotics fail, a surgical exchange, in which the infected implant is simultaneously replaced with a new one, should be considered. This is a complex procedure, but some surgeons have reported a 90% success rate.

Vascular Surgery

For men whose impotence is caused by damage to the arteries or blood vessels, vascular surgery might be an option. Two types of operations are available: revascularization (or bypass) surgery, and venous ligation. The American Urologic Association stresses that vascular surgery is still investigative.

Revascularization. The revascularization procedure is affected by taking an artery from a leg and then surgically connecting it to the arteries at the back of the penis, bypassing the blockages and restoring blood flow. Young men with local sites of arterial blockage generally achieve the best results. Candidates should have a percentage of smooth muscle tissue of at least 29%. In studies of selected patients there was improvement in erectile dysfunction in 50% to 75% of men after five years.

Venous Ligation. Venous ligation is performed when the penis is unable to store a sufficient amount of blood to maintain an erection. This operation ties off or removes veins that are causing an excessive amount of blood to drain from the erection chambers. The success rate is estimated at between 40% and 50% initially, but drops to 15% over the long term. It is important to find a surgeon experienced in this surgery. 

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