Efficacy and compliance of early use vacuum constriction device for erectile dysfunction following radical prostatectomy

Abstract

Objective: To assess the efficacy and compliance of vacuum constriction device (VCD) following radical prostatectomy (RP) and to determiner whether its early use can potentially prevent corporeal fibrosis and expedite recovery of erectile function.Design: Prospective study.Materials/Methods: Following RP and catheter removal, 74 patients were instructed to use VCD daily (with or without constriction ring) to induce intracavernous pressure and tumescence. The constriction ring was applied if sexual intercourse was attempted. Early use of VCD began at an average of 3.9 wks (2–8 wks) after surgery and the mean follow-up was 8 months (6–9 mo). The treatment efficacy was analyzed by responses to SHIM <abridged 5-item International Index of Erectile Function (IIEF)>and stratified by nerve-sparing status. Patient outcome regarding compliance, return of natural erection, and ability for vaginal intercourse was assessed.Results: The average age of men contacted for follow-up was 58.6 ± 5.25 (range 50–71). All patients who were contacted for the study had used their VCD, with a compliance rate of 80% (60/74). After mean use of 3 months 14/74 (18%) discontinued treatment. The causes of discontinuation were: discomfort with the pump 55%, unable to get airtight seal 8%, social inconvenience 17%, and penile bruising 20%. Eighty percent (60/74) successfully used VCD with constriction ring for vaginal intercourse at a frequency of twice/week with an overall spousal satisfaction rage of 55% (33/60). Nineteen out of 60 (32%) reported return of natural erections at mean interval of 9 months with 10/19 (52%) patients having erections sufficient for vaginal penetration. The abridged IIEF score was significantly increased after VCD use in both nerve-sparing and non-nerve-sparing groups (Table). TableComparison between patients with nerve-sparing (NS) and non-NS RP in response to early use of VCDVariableBilateral NS (n = 25)Unilateral NS (n = 19)Non-NS (n = 16)Return of natural erection with VCD at 6–9 mo36% (9/25)37% (7/19)19% (3/16)Natural erection sufficient for intercourse at 6–9 mo55% (5/9)57% (4/7)33% (1/3)Spousal satisfaction52% (13/25)57% (11/19)57% (9/16)IIEF-5 QuestionnairePre-RPPost-RPAfter early VCD UseIIEF Q5 - Maintenance ability4.10 ± 0.860.99 ± 0.723.61 ± 1.47IIEF Q15 - Erection confidence4.33 ± 0.960.86 ± 0.753.24 ± 1.43IIEF Q4 - Maintenance frequency4.76 ± 0.860.91 ± 1.652.64 ± 1.46IIEF Q2 - Erection firmness4.81 ± 0.740.91 ± 0.753.14 ± 1.40IIEF Q7 - Intercourse satisfaction4.46 ± 0.801.11 ± 0.753.12 ± 1.57Total IIEF-5 score22.5 ± 4.224.8 ± 4.6216 ± 7.33Data are presented as mean ± SD unless otherwise specified. Open table in a new tab Conclusions: Early use of VCD following RP facilitates early sexual intercourse, early patient/spousal sexual satisfaction, and, potentially, an earlier return of natural erections.Supported by: None. Objective: To assess the efficacy and compliance of vacuum constriction device (VCD) following radical prostatectomy (RP) and to determiner whether its early use can potentially prevent corporeal fibrosis and expedite recovery of erectile function. Design: Prospective study. Materials/Methods: Following RP and catheter removal, 74 patients were instructed to use VCD daily (with or without constriction ring) to induce intracavernous pressure and tumescence. The constriction ring was applied if sexual intercourse was attempted. Early use of VCD began at an average of 3.9 wks (2–8 wks) after surgery and the mean follow-up was 8 months (6–9 mo). The treatment efficacy was analyzed by responses to SHIM <abridged 5-item International Index of Erectile Function (IIEF)>and stratified by nerve-sparing status. Patient outcome regarding compliance, return of natural erection, and ability for vaginal intercourse was assessed. Results: The average age of men contacted for follow-up was 58.6 ± 5.25 (range 50–71). All patients who were contacted for the study had used their VCD, with a compliance rate of 80% (60/74). After mean use of 3 months 14/74 (18%) discontinued treatment. The causes of discontinuation were: discomfort with the pump 55%, unable to get airtight seal 8%, social inconvenience 17%, and penile bruising 20%. Eighty percent (60/74) successfully used VCD with constriction ring for vaginal intercourse at a frequency of twice/week with an overall spousal satisfaction rage of 55% (33/60). Nineteen out of 60 (32%) reported return of natural erections at mean interval of 9 months with 10/19 (52%) patients having erections sufficient for vaginal penetration. The abridged IIEF score was significantly increased after VCD use in both nerve-sparing and non-nerve-sparing groups (Table). Data are presented as mean ± SD unless otherwise specified. Conclusions: Early use of VCD following RP facilitates early sexual intercourse, early patient/spousal sexual satisfaction, and, potentially, an earlier return of natural erections. Supported by: None.